{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T09:22:45Z","timestamp":1773393765969,"version":"3.50.1"},"reference-count":19,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T00:00:00Z","timestamp":1621296000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"British Society of Gastroenterology"},{"name":"Health Quality Improvement Partnership"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2021,3,18]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Centres provided information about staffing, infrastructure and patient management (measured against predefined guideline-based standards) via a web-based data collection tool.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Hospitals (14 university hospitals (UHs), 14 district general hospitals (DGHs)) had median (range) of 8 (3\u201323) gastroenterologists; including 3 (0\u201310) hepatologists. Eight hospitals (29%, all DGHs) had no hepatologist. In individual hospital departments, there were 50% (18\u2013100) of all consultants managing AIH: in DGH\u2019s 92% (20\u2013100) vs 46% (17\u2013100) 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&lt;0.001).<\/jats:p>\n                  <jats:p>Of 999 steroid-treated patients with \u226512\u2009months follow-up, 25% received steroids for &lt;12\u2009months. After 1\u2009year 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/flgastro-2020-101661","type":"journal-article","created":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T13:20:30Z","timestamp":1621344030000},"page":"126-132","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH)"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8898-4523","authenticated-orcid":false,"given":"Victoria Mary","family":"Gordon","sequence":"first","affiliation":[{"name":"Hepatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ratul","family":"Adhikary","sequence":"additional","affiliation":[{"name":"Calderdale Royal Hospital, Halifax, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guruprasad P","family":"Aithal","sequence":"additional","affiliation":[{"name":"Nottingham Digestive Disease Centre, NIHR Biomedical Research Unit,Nottingham University, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Appleby","sequence":"additional","affiliation":[{"name":"Gastroenterology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debasish","family":"Das","sequence":"additional","affiliation":[{"name":"Kettering General Hospital, Kettering, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Day","sequence":"additional","affiliation":[{"name":"Addenbrooke's Hospital, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toby","family":"Delahooke","sequence":"additional","affiliation":[{"name":"Leicester Royal Infirmary, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selena","family":"Dixon","sequence":"additional","affiliation":[{"name":"Airedale NHS Foundation Trust, Keighley, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Elphick","sequence":"additional","affiliation":[{"name":"Chesterfield Royal Hospital, Chesterfield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Hardie","sequence":"additional","affiliation":[{"name":"Freeman Hospital, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Heneghan","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Hoeroldt","sequence":"additional","affiliation":[{"name":"Rotherham General Hospitals NHS Trust, Rotherham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Hooper","sequence":"additional","affiliation":[{"name":"Derby Teaching Hospitals NHS Foundation Trust, Derby, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Hepatology, York Teaching Hospital NHS Foundation Trust, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca L","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Hepatology, St James's University Hospital, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faisal","family":"Khan","sequence":"additional","affiliation":[{"name":"Doncaster Royal Infirmary, Doncaster, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Metcalf","sequence":"additional","affiliation":[{"name":"North Tees University Hospital, North Tees, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alick","family":"Nkhoma","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stavroula","family":"Pelitari","sequence":"additional","affiliation":[{"name":"Hepatology, University Hospitals Coventry and Warwickshire NHS Trust Gastroenterology, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Prince","sequence":"additional","affiliation":[{"name":"Manchester Royal Infirmary, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annell","family":"Prosser","sequence":"additional","affiliation":[{"name":"Singleton Hospital, Swansea, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sushma","family":"Saksena","sequence":"additional","affiliation":[{"name":"The Royal London Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinay","family":"Sathyanarayana","sequence":"additional","affiliation":[{"name":"Barnsley District General Hospital NHS Trust, Barnsley, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deven","family":"Vani","sequence":"additional","affiliation":[{"name":"Mid Yorkshire Hospitals NHS Trust, Wakefield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0739-3332","authenticated-orcid":false,"given":"Andrew","family":"Yeoman","sequence":"additional","affiliation":[{"name":"Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dermot","family":"Gleeson","sequence":"additional","affiliation":[{"name":"Hepatology, Royal Hallamshire Hospital, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,5,18]]},"reference":[{"key":"2025090709113552000_13.2.126.1","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.jhep.2013.10.020","article-title":"Autoimmune hepatitis in Denmark: incidence, prevalence, prognosis, and causes of death. 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A Census of Medical Workforce & Infrastructure for Liver Disease Strategy. Summary of findings (final 2011), 2011. Available: http:\/\/www.hcvaction.org.uk\/resource\/census-medical-workforce-infrastructure-liver-disease-strategy-summary-findings"},{"key":"2025090709113552000_13.2.126.12","unstructured":"Committee, B.C.S.a.S . Survey of service provision in UK trusts. Data on file Bsg; 2018."},{"key":"2025090709113552000_13.2.126.13","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/S0140-6736(19)32908-3","article-title":"Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK","volume":"395","author":"Williams","year":"2020","journal-title":"The Lancet"},{"key":"2025090709113552000_13.2.126.14","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1111\/liv.13724","article-title":"Diagnosis, presentation and initial severity of autoimmune hepatitis (AIH) in patients attending 28 hospitals in the UK","volume":"38","author":"Gordon","year":"2018","journal-title":"Liver Int"},{"key":"2025090709113552000_13.2.126.15","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1038\/ajg.2015.139","article-title":"Long-Term prognostic significance of persisting histological activity despite biochemical remission in autoimmune hepatitis","volume":"110","author":"Dhaliwal","year":"2015","journal-title":"Am J Gastroenterol"},{"key":"2025090709113552000_13.2.126.16","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/apt.14968","article-title":"Inequity of care provision and outcome disparity in autoimmune hepatitis in the United Kingdom","volume":"48","author":"Dyson","year":"2018","journal-title":"Aliment Pharmacol Ther"},{"key":"2025090709113552000_13.2.126.17","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1016\/j.cgh.2018.12.035","article-title":"Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis","volume":"17","author":"Pape","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025090709113552000_13.2.126.18","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1002\/hep.30031","article-title":"The impact of autoimmune hepatitis and its treatment on health utility","volume":"68","author":"Wong","year":"2018","journal-title":"Hepatology"},{"key":"2025090709113552000_13.2.126.19","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.12-2-114"}],"container-title":["Frontline Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/flgastro-2020-101661","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T16:11:44Z","timestamp":1757261504000},"score":1,"resource":{"primary":{"URL":"https:\/\/fg.bmj.com\/lookup\/doi\/10.1136\/flgastro-2020-101661"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,18]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,7]]},"published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1136\/flgastro-2020-101661"],"URL":"https:\/\/doi.org\/10.1136\/flgastro-2020-101661","relation":{},"ISSN":["2041-4137","2041-4145"],"issn-type":[{"value":"2041-4137","type":"print"},{"value":"2041-4145","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,18]]}}}