Letter to editor re: Spectrum of Autoimmune Liver Disease and Real-World Treatment Experience from a Tertiary Care Hospital

We note, in Taneja et al’s interesting review of real world experience autoimmune liver disease, the proportion with cross over syndromes (AIH-PSC, n=18; or AIH-PBC, n=18, among a total number patient 275) [1Taneja S. Mehtani R. De A. Mitra Rathi Verma N. Premkumar M. Minz Duseja Das Singh V. Dhiman R.K. Chawla Y.K. Spectrum Autoimmune Liver Disease and Real-World Treatment Experience from Tertiary Care Hospital.J Clin Exp Hepatol. 2023 Mar-Apr; 13: 241-251https://doi.org/10.1016/j.jceh.2022.11.002Abstract Full Text PDF Scopus (0) Google Scholar]. Thinking about these conditions has developed recently, we refer readers to Ricciuto opinion article Journal Hepatology [2Ricciuto Kamath B.M. Hirschfield G.M. Trivedi P.J. Primary sclerosing cholangitis overlap features hepatitis: coming age an age-ist problem?.J Mar 2; S0168-S8278 (Epub ahead print. PMID: 36870613): 00162-00169https://doi.org/10.1016/j.jhep.2023.02.030Abstract They counsel caution commencing immunosuppressive therapy, postulating that AIH component is part PSC spectrum, not separable entity will reliably respond treatment. Or, if does, cholangiopathy may not. note this cohort, 61% AIH-PSC group showed complete response treatment, though long term follow-up data available. Regarding AIH-PBC expert guidance highlighted ‘true’ rare, it more common see inflammatory accompanying PBC, possibly indicating aggressive course but requiring immunosuppression [3Hirschfield Dyson J.K. Alexander G.J.M. al.The British Society Gastroenterology/UK-PBC primary biliary treatment management guidelinesGut. 2018; 67: 1568-1594Google Applicable both situations, at times phenotypic one disease dominate other. It well observed less satisfactory when there are two apparent phenotypes. call understand PSC/AIH AISC as continuum speaks our need, clinicians, place patients their into categories. The 'representiveness heuristic' sees humans recognise certain salient make assumption unfamiliar pattern behave according expectations reference condition (AIH case) know AIH, comfortable it. In AISC, hepatologists provided attractive – sub-type immune suppression. This can influence way speak young parents. challenging current terminology they encourage us widen perspective, accept treating activity be justified, explore uncertainty patients. While families initiate immunosupressive therapy some cases, important allow concrete concepts develop, for stands able offer confident prognoses, certainly cannot translate older cohorts teenagers younger adults without remaining aware risks. 4Kahneman Daniel Tversky Amos "Subjective probability: A judgment representativeness" (PDF).Cognitive Psychology. 1972; 3: 430-454https://doi.org/10.1016/0010-0285(72)90016-3Crossref (2508) Scholar. none.