Autoimmune Hepatitis Prevalence among Patients from Saudi Arabia with Chronic Liver Disease Referred for Transient Elastography

Background and study aim: Autoimmune hepatitis (AIH) is a chronic liver disease that can lead to progressive liver damage. The prevalence of AIH among the general population and among chronic liver disease (CLD) patients is variable worldwide. Currently, no published data on the prevalence of AIH among Saudi or among liver disease patients from the region. In this study, we aimed to assess the prevalence of AIH among CLD patients who were referred for transient elastography (FibroScan) in Saudi Arabia. Patients and methods: A retrospective study was conducted among CLD patients who had a transient elastography (FibroScan) during the 3-year study period. We obtained demographic data and test results for serum alanine aminotransferase (ALT), bilirubin, hemoglobin (Hgb), platelets, and international normalized ratio (INR) from all patients. We compared the results of the AIH patients to those of the non-AIH patients with CLD. In addition, for AIH patients, we measured serum immunoglobulin G (IgG), antinuclear antibody (ANA), smooth muscle antibody (SMA) and ALT at 2 - 6 weeks and at 3 - 4 months. Results: We included 494 patients, who were predominantly female (271 (60%)) and Saudi (299 (60.5%)). Thirty patients (6.1%) had AIH, which represented the 4th most common liver disease. Compared to non-AIH patients, AIH patients were younger (mean ages 49.9 years, SD 14.22 years, and 40.4 years, SD 13.94 years, respectively, P = 0.001). Patients with AIH had significantly lower Hgb and platelets (P = 0.008 for both) and higher ALT, bilirubin and INR (P = 0.05, 0.047 and 0.019, respectively). More than 50% of the AIH patients had cirrhosis. Older age was not associated with advanced disease stage among the AIH patients (P < 0.001). AIH represents the 4th most common cause of CLD in patients referred for transient elastography in Saudi Arabia. AIH tends to be severe in patients at a young age, with a marked biochemical response to steroids and azathioprine treatment.

Causes and Stages of Hepatocellular Carcinoma at Patient Presentation at a Tertiary Medical Center in Western Saudi Arabia

Background: With 748,300 new cases diagnosed every year, hepatocellular carcinoma (HCC) is the 5th?and the 7th?most common cancer among males and females, respectively, and causes 7% of all cancer-related deaths. HCC represents more than?90% of primary liver cancers. Objective: The aim of the present study was to recognize the stages of HCC at presentation in patients who were diagnosed at King Abdul Aziz University Hospital (KAUH) and to identify the associated laboratory features of advance HCC.?Materials and Methods: A retrospective analysis of 57 HCC patients admitted to KAUH between January 2008 and December 2012 was conducted. The diagnosis was established using ultrasound (U/S), computed tomography (CT) and/or magnetic resonance imaging (MRI), with or without a liver biopsy, as well as blood testing for alpha-fetoprotein.?The following data were extracted from the medical records at KAUH: patient demographics (age, sex and nationality), laboratory results (CBC, LFT, PT, INR and alpha-fetoprotein), radiological results, biopsy results for those patients who underwent biopsy, outcomes (living, deceased or lost from the follow-up), and mortality and survival rates. Results: A total of 57 HCC patients were admitted during the study period, and 3 patients were excluded from the analysis. Of the remaining 54 patients, 44 (81.5%) were males and 10 (18.5%) were females. The mean age was 64.54 years (SD, 11.2 years;range, 31?-?86 years). The majority of patients were Saudis (19, 35.2%), non-Saudis (35, 64.8%), Egyptians (9, 16.6%) and Yemenis (7, 13%). The remaining 19 (35.2%) patients comprised other nationalities. Chronic hepatitis C virus was the most common cause for liver cirrhosis (35 patients, 64.8%). CT was the primary diagnostic method (37 patients 68.5%), while 9 (16.7%) cases were confirmed by adnominal MRI. Six patients (11.1%) were diagnosed with abdominal ultrasound examination and elevated alpha-fetoprotein levels. In 2 (3.7%) patients, HCC was confirmed by liver biopsy. The majority of the patients (37, 68.5%) had advanced disease. Only 21 (39%) patients underwent radio frequency appellation (RFA). The mean survival time from diagnosis to death was 5.9 months (SD, 5.7 months), and the longest survival time to death was 20 months. Conclusion: The majority of our patients presented at an advanced disease stage, and CHC was the most common underlying cause for liver cirrhosis in our cohort of HCC patients. The proper implementation of HCC screening programs for cirrhotic patients is expected to help detect the treatable stages of HCC in a timely manner.