학술논문
Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH).
Document Type
Academic Journal
Author
Gordon VM; Hepatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.; Adhikary R; Calderdale Royal Hospital, Halifax, UK.; Aithal GP; Nottingham Digestive Disease Centre, NIHR Biomedical Research Unit, Nottingham University, Nottingham, UK.; Appleby V; Gastroenterology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK.; Das D; Kettering General Hospital, Kettering, UK.; Day J; Addenbrooke's Hospital, Cambridge, UK.; Delahooke T; Leicester Royal Infirmary, Leicester, UK.; Dixon S; Airedale NHS Foundation Trust, Keighley, UK.; Elphick D; Chesterfield Royal Hospital, Chesterfield, UK.; Hardie C; Freeman Hospital, Newcastle upon Tyne, UK.; Heneghan M; Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.; Hoeroldt B; Rotherham General Hospitals NHS Trust, Rotherham, UK.; Hooper P; Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.; Hutchinson J; Hepatology, York Teaching Hospital NHS Foundation Trust, York, UK.; Jones RL; Department of Hepatology, St James's University Hospital, Leeds, UK.; Khan F; Doncaster Royal Infirmary, Doncaster, UK.; Metcalf J; North Tees University Hospital, North Tees, UK.; Nkhoma A; Gastroenterology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.; Pelitari S; Hepatology, University Hospitals Coventry and Warwickshire NHS Trust Gastroenterology, Coventry, UK.; Prince M; Manchester Royal Infirmary, Manchester, UK.; Prosser A; Singleton Hospital, Swansea, UK.; Saksena S; The Royal London Hospital, London, UK.; Sathyanarayana V; Barnsley District General Hospital NHS Trust, Barnsley, UK.; Vani D; Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.; Yeoman A; Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, UK.; Gleeson D; Hepatology, Royal Hallamshire Hospital, Sheffield, UK.
Source
Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 101528589 Publication Model: eCollection Cited Medium: Print ISSN: 2041-4137 (Print) Linking ISSN: 20414137 NLM ISO Abbreviation: Frontline Gastroenterol Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2041-4137
Abstract
Background: Autoimmune hepatitis (AIH) is a substantial UK health burden, but there is variation in care, facilities and in opinion regarding management. We conducted an audit of service provision and care of patients with AIH in 28 UK hospitals.
Methods: Centres provided information about staffing, infrastructure and patient management (measured against predefined guideline-based standards) via a web-based data collection tool.
Results: Hospitals (14 university hospitals (UHs), 14 district general hospitals (DGHs)) had median (range) of 8 (3-23) gastroenterologists; including 3 (0-10) hepatologists. Eight hospitals (29%, all DGHs) had no hepatologist. In individual hospital departments, there were 50% (18-100) of all consultants managing AIH: in DGH's 92% (20-100) vs 46% (17-100) in UHs. Specialist nurses managed AIH in only 18%. Seventeen (61%) hospitals had a histopathologist with a liver interest, these were more likely to find rosettes than those without (172/795 vs 50/368; p<0.001).Of 999 steroid-treated patients with ≥12 months follow-up, 25% received steroids for <12 months. After 1 year of treatment, 82% of patients achieved normal serum alanine aminotransaminase (ALT); this was higher in UHs than DGHs. Three-monthly liver blood tests were inadequately recorded in 26%. Of potentially eligible patients with liver decompensation, transplantation was apparently not considered in 5% (n=7). The same standards were attained in different types of hospital.
Conclusion: Management of AIH in UK hospitals is often shared between most gastroenterologists. Blood test monitoring and treatment duration are not always in line with recommendations. Some eligible patients with decompensation are not discussed with transplant teams. Care might be improved by expanding specialist input and management by fewer designated consultants.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
Methods: Centres provided information about staffing, infrastructure and patient management (measured against predefined guideline-based standards) via a web-based data collection tool.
Results: Hospitals (14 university hospitals (UHs), 14 district general hospitals (DGHs)) had median (range) of 8 (3-23) gastroenterologists; including 3 (0-10) hepatologists. Eight hospitals (29%, all DGHs) had no hepatologist. In individual hospital departments, there were 50% (18-100) of all consultants managing AIH: in DGH's 92% (20-100) vs 46% (17-100) in UHs. Specialist nurses managed AIH in only 18%. Seventeen (61%) hospitals had a histopathologist with a liver interest, these were more likely to find rosettes than those without (172/795 vs 50/368; p<0.001).Of 999 steroid-treated patients with ≥12 months follow-up, 25% received steroids for <12 months. After 1 year of treatment, 82% of patients achieved normal serum alanine aminotransaminase (ALT); this was higher in UHs than DGHs. Three-monthly liver blood tests were inadequately recorded in 26%. Of potentially eligible patients with liver decompensation, transplantation was apparently not considered in 5% (n=7). The same standards were attained in different types of hospital.
Conclusion: Management of AIH in UK hospitals is often shared between most gastroenterologists. Blood test monitoring and treatment duration are not always in line with recommendations. Some eligible patients with decompensation are not discussed with transplant teams. Care might be improved by expanding specialist input and management by fewer designated consultants.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)