Curbside Consultation of the Liver: 49 Clinical Questions

Mitchell L. Shiffman, MD

Question 25: Do I Need To Perform A Liver Biopsy In All Patients With Autoimmune Hepatitis Prior To Initiating Steroids? (continued)

Andres Mogollon, MD; R. Todd Stravitz, MD

Yes. Patients with suspected autoimmune hepatitis should undergo a liver biopsy before initiating corticosteroids for several reasons: 1. To establish the diagnosis of AIH. AIH can be a difficult diagnosis, and there are no noninvasively obtained data that unequivocally establish the diagnosis. In fact, an international consensus conference has published an AIH score based upon numerous clinical and laboratory parameters, including liver histology, to improve the accuracy of the diagnosis (Table 25-1). Furthermore, up to 15% of patients with AIH have negative immune…