Treatment of autoimmune hepatitis: what is the optimal end point on follow-up biopsy?
Introduction The authors have reported1 that following immunosuppressive treatment of Autoimmune Hepatitis (AIH), many patients fail to achieve histological remission (necro-inflammatory score (NIS) ≥3), despite attaining biochemical remission (normal serum ALT). A recent report2 suggests that, foll...
Saved in:
Published in | Gut Vol. 60; no. Suppl 1; p. A229 |
---|---|
Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
London
BMJ Publishing Group Ltd and British Society of Gastroenterology
01.04.2011
BMJ Publishing Group LTD |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Introduction The authors have reported1 that following immunosuppressive treatment of Autoimmune Hepatitis (AIH), many patients fail to achieve histological remission (necro-inflammatory score (NIS) ≥3), despite attaining biochemical remission (normal serum ALT). A recent report2 suggests that, following treatment, a NIS≥5 is not associated with fibrosis progression and hence, may be an acceptable treatment outcome.2 The authors therefore aimed to assess the associations of NIS on follow-up biopsy within the range 0–5, with change in fibrosis and survival. Methods The authors studied 114 patients with AIH by IAIHG criteria (81 definite, 94 female, mean age 48.7±1.7 years), treated initially with reducing dose prednisolone and 1 mg/kg azathioprine, who had achieved normal serum ALT and a NIS between 0 and 5 on follow-up biopsy (performed at median (range) 2.16 (0.65–13.67) years) after diagnosis (paired diagnostic and follow-up biopsies available in 93 patients). Biopsies were graded using the Ishak system. Results Fibrosis score between baseline and follow-up biopsy decreased in patients with follow-up NIS 0–3 (mean 3.4±0.24 to 2.7±0.21, n=59 p=0.001) but was unchanged in those with follow-up NIS of 4 or 5 (3.5±0.3 to 3.4±0.3, n=34 p=0.846). Fibrosis score on follow-up biopsy was higher in patients with NIS 4–5 (n=40) than with NIS 0–3 (n=72) (mean 3.3±0.3 vs 2.4±0.2, p=0.014). Regression of fibrosis was independently associated with lower NIS (p=0.014) and less portal inflammation (p=0.006) on follow-up biopsy, and with longer interval between the two biopsies (p=0.001). All cause death/transplantation rate was higher in those with NIS of 4–5 than in those with NIS 0–3 (18% vs 6% and 64% vs 24% after 10 and 20 years respectively; p<0.001) and this categorisation was independently associated with survival (p=0.001). A similar trend for liver death/transplantation just failed to reach significance (p=0.07). Conclusion In patients with AIH treated with immunosupression, even mild histological activity (NIS 4 or 5) on follow-up biopsy is associated with more fibrosis and with reduced survival and hence may not be an optimal end point of treatment. |
---|---|
AbstractList | INTRODUCTION: The authors have reported1 that following immunosuppressive treatment of Autoimmune Hepatitis (AIH), many patients fail to achieve histological remission (necro-inflammatory score (NIS) greater than or equal to 3), despite attaining biochemical remission (normal serum ALT). A recent report2 suggests that, following treatment, a NIS greater than or equal to 5 is not associated with fibrosis progression and hence, may be an acceptable treatment outcome.2 The authors therefore aimed to assess the associations of NIS on follow-up biopsy within the range 0-5, with change in fibrosis and survival. METHODS: The authors studied 114 patients with AIH by IAIHG criteria (81 definite, 94 female, mean age 48.7 plus or minus 1.7 years), treated initially with reducing dose prednisolone and 1 mg/kg azathioprine, who had achieved normal serum ALT and a NIS between 0 and 5 on follow-up biopsy (performed at median (range) 2.16 (0.65-13.67) years) after diagnosis (paired diagnostic and follow-up biopsies available in 93 patients). Biopsies were graded using the Ishak system. RESULTS: Fibrosis score between baseline and follow-up biopsy decreased in patients with follow-up NIS 0-3 (mean 3.4 plus or minus 0.24 to 2.7 plus or minus 0.21, n=59 p=0.001) but was unchanged in those with follow-up NIS of 4 or 5 (3.5 plus or minus 0.3 to 3.4 plus or minus 0.3, n=34 p=0.846). Fibrosis score on follow-up biopsy was higher in patients with NIS 4-5 (n=40) than with NIS 0-3 (n=72) (mean 3.3 plus or minus 0.3 vs 2.4 plus or minus 0.2, p=0.014). Regression of fibrosis was independently associated with lower NIS (p=0.014) and less portal inflammation (p=0.006) on follow-up biopsy, and with longer interval between the two biopsies (p=0.001). All cause death/transplantation rate was higher in those with NIS of 4-5 than in those with NIS 0-3 (18% vs 6% and 64% vs 24% after 10 and 20 years respectively; p<0.001) and this categorisation was independently associated with survival (p=0.001). A similar trend for liver death/transplantation just failed to reach significance (p=0.07). CONCLUSION: In patients with AIH treated with immunosupression, even mild histological activity (NIS 4 or 5) on follow-up biopsy is associated with more fibrosis and with reduced survival and hence may not be an optimal end point of treatment. Introduction The authors have reported1 that following immunosuppressive treatment of Autoimmune Hepatitis (AIH), many patients fail to achieve histological remission (necro-inflammatory score (NIS) ≥3), despite attaining biochemical remission (normal serum ALT). A recent report2 suggests that, following treatment, a NIS≥5 is not associated with fibrosis progression and hence, may be an acceptable treatment outcome.2 The authors therefore aimed to assess the associations of NIS on follow-up biopsy within the range 0–5, with change in fibrosis and survival. Methods The authors studied 114 patients with AIH by IAIHG criteria (81 definite, 94 female, mean age 48.7±1.7 years), treated initially with reducing dose prednisolone and 1 mg/kg azathioprine, who had achieved normal serum ALT and a NIS between 0 and 5 on follow-up biopsy (performed at median (range) 2.16 (0.65–13.67) years) after diagnosis (paired diagnostic and follow-up biopsies available in 93 patients). Biopsies were graded using the Ishak system. Results Fibrosis score between baseline and follow-up biopsy decreased in patients with follow-up NIS 0–3 (mean 3.4±0.24 to 2.7±0.21, n=59 p=0.001) but was unchanged in those with follow-up NIS of 4 or 5 (3.5±0.3 to 3.4±0.3, n=34 p=0.846). Fibrosis score on follow-up biopsy was higher in patients with NIS 4–5 (n=40) than with NIS 0–3 (n=72) (mean 3.3±0.3 vs 2.4±0.2, p=0.014). Regression of fibrosis was independently associated with lower NIS (p=0.014) and less portal inflammation (p=0.006) on follow-up biopsy, and with longer interval between the two biopsies (p=0.001). All cause death/transplantation rate was higher in those with NIS of 4–5 than in those with NIS 0–3 (18% vs 6% and 64% vs 24% after 10 and 20 years respectively; p<0.001) and this categorisation was independently associated with survival (p=0.001). A similar trend for liver death/transplantation just failed to reach significance (p=0.07). Conclusion In patients with AIH treated with immunosupression, even mild histological activity (NIS 4 or 5) on follow-up biopsy is associated with more fibrosis and with reduced survival and hence may not be an optimal end point of treatment. Introduction The authors have reported 1 that following immunosuppressive treatment of Autoimmune Hepatitis (AIH), many patients fail to achieve histological remission (necro-inflammatory score (NIS) ≥3), despite attaining biochemical remission (normal serum ALT). A recent report 2 suggests that, following treatment, a NIS≥5 is not associated with fibrosis progression and hence, may be an acceptable treatment outcome. 2 The authors therefore aimed to assess the associations of NIS on follow-up biopsy within the range 0-5, with change in fibrosis and survival. Methods The authors studied 114 patients with AIH by IAIHG criteria (81 definite, 94 female, mean age 48.7±1.7 years), treated initially with reducing dose prednisolone and 1 mg/kg azathioprine, who had achieved normal serum ALT and a NIS between 0 and 5 on follow-up biopsy (performed at median (range) 2.16 (0.65-13.67) years) after diagnosis (paired diagnostic and follow-up biopsies available in 93 patients). Biopsies were graded using the Ishak system. Results Fibrosis score between baseline and follow-up biopsy decreased in patients with follow-up NIS 0-3 (mean 3.4±0.24 to 2.7±0.21, n=59 p=0.001) but was unchanged in those with follow-up NIS of 4 or 5 (3.5±0.3 to 3.4±0.3, n=34 p=0.846). Fibrosis score on follow-up biopsy was higher in patients with NIS 4-5 (n=40) than with NIS 0-3 (n=72) (mean 3.3±0.3 vs 2.4±0.2, p=0.014). Regression of fibrosis was independently associated with lower NIS (p=0.014) and less portal inflammation (p=0.006) on follow-up biopsy, and with longer interval between the two biopsies (p=0.001). All cause death/transplantation rate was higher in those with NIS of 4-5 than in those with NIS 0-3 (18% vs 6% and 64% vs 24% after 10 and 20 years respectively; p<0.001) and this categorisation was independently associated with survival (p=0.001). A similar trend for liver death/transplantation just failed to reach significance (p=0.07). Conclusion In patients with AIH treated with immunosupression, even mild histological activity (NIS 4 or 5) on follow-up biopsy is associated with more fibrosis and with reduced survival and hence may not be an optimal end point of treatment. |
Author | McFarlane, E Karajeh, M A Dhaliwal, H K Gleeson, D C Dube, A Hoeroldt, B S |
Author_xml | – sequence: 1 givenname: H K surname: Dhaliwal fullname: Dhaliwal, H K organization: Liver Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK – sequence: 2 givenname: B S surname: Hoeroldt fullname: Hoeroldt, B S organization: Gastroenterology, Rotherham General Hospital, Rotherham, UK – sequence: 3 givenname: A surname: Dube fullname: Dube, A organization: Department of Histopathology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK – sequence: 4 givenname: E surname: McFarlane fullname: McFarlane, E organization: Liver Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK – sequence: 5 givenname: M A surname: Karajeh fullname: Karajeh, M A organization: Liver Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK – sequence: 6 givenname: D C surname: Gleeson fullname: Gleeson, D C organization: Liver Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK |
BookMark | eNqNkEtv1DAURi3USkyn_QVsLLFgldT2jR9hg2CAglS1i7awtJzEZjwkcRo7Kv33eBTEghWrK12d7z7OGToZw2gRekVJSSmIyx9LKhmhtGRQA6FlpeAF2tBKqAKYUidoQwiVBZdV_RKdxXgghChV0w16uJ-tSYMdEw4OmyUFPwzLaPHeTib55ONb_LQ3CfuI097iMCU_mB7bscNT8MfYiF3o-_BULBNufJji87tzdOpMH-3Fn7pFD58_3e--FNe3V19376-LhjEBhasFN50B2tEWKk6YA6gcyM5ZwcCZWpq2Mq4homuk7GzLlW0cI7nJK6k4bNGbde40h8fFxqQHH1vb92a0YYm6JpJyIXiVydf_kIewzGM-TjMCSgLIXLcIVqqdQ4yzdXqa87vzs6ZEH03rbFofTevVtM6mc6pYUz4m--tvxMw_tZAgub75ttN3H-obKT5-13eZL1e-GQ7_teA3D1mRBA |
ContentType | Journal Article |
Copyright | Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions Copyright: 2011 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions |
Copyright_xml | – notice: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions – notice: Copyright: 2011 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions |
DBID | BSCLL AAYXX CITATION 3V. 7X7 7XB 88E 88I 8AF 8FE 8FH 8FI 8FJ 8FK ABUWG AFKRA AZQEC BBNVY BENPR BHPHI BTHHO CCPQU DWQXO FYUFA GHDGH GNUQQ HCIFZ K9. LK8 M0S M1P M2P M7P PQEST PQQKQ PQUKI PRINS Q9U 7T5 7U9 H94 |
DOI | 10.1136/gut.2011.239301.483 |
DatabaseName | Istex CrossRef ProQuest Central (Corporate) ProQuest Health & Medical Collection ProQuest Central (purchase pre-March 2016) Medical Database (Alumni Edition) Science Database (Alumni Edition) STEM Database ProQuest SciTech Collection ProQuest Natural Science Collection Hospital Premium Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Central (Alumni) ProQuest Central UK/Ireland ProQuest Central Essentials Biological Science Collection AUTh Library subscriptions: ProQuest Central ProQuest Natural Science Collection BMJ Journals ProQuest One Community College ProQuest Central Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Central Student SciTech Premium Collection (Proquest) (PQ_SDU_P3) ProQuest Health & Medical Complete (Alumni) Biological Sciences Health & Medical Collection (Alumni Edition) Medical Database ProQuest Science Journals Biological Science Database ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Academic ProQuest One Academic UKI Edition ProQuest Central China ProQuest Central Basic Immunology Abstracts Virology and AIDS Abstracts AIDS and Cancer Research Abstracts |
DatabaseTitle | CrossRef ProQuest Central Student ProQuest Central Essentials ProQuest Health & Medical Complete (Alumni) ProQuest AP Science ProQuest Central (Alumni Edition) SciTech Premium Collection ProQuest One Community College ProQuest Natural Science Collection ProQuest Central China ProQuest Central Health Research Premium Collection Health and Medicine Complete (Alumni Edition) Natural Science Collection ProQuest Central Korea Biological Science Collection ProQuest Medical Library (Alumni) ProQuest Science Journals (Alumni Edition) ProQuest Biological Science Collection ProQuest Central Basic ProQuest Science Journals ProQuest One Academic Eastern Edition ProQuest Hospital Collection Health Research Premium Collection (Alumni) Biological Science Database ProQuest SciTech Collection ProQuest Hospital Collection (Alumni) ProQuest Health & Medical Complete ProQuest Medical Library ProQuest One Academic UKI Edition BMJ Journals ProQuest One Academic ProQuest Central (Alumni) AIDS and Cancer Research Abstracts Immunology Abstracts Virology and AIDS Abstracts |
DatabaseTitleList | AIDS and Cancer Research Abstracts ProQuest Central Student |
Database_xml | – sequence: 1 dbid: BENPR name: AUTh Library subscriptions: ProQuest Central url: https://www.proquest.com/central sourceTypes: Aggregation Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1468-3288 |
EndPage | A229 |
ExternalDocumentID | 10_1136_gut_2011_239301_483 ark_67375_NVC_SB9N76DW_S |
GroupedDBID | --- .55 .GJ .VT 08G 0R~ 18M 29I 2WC 354 39C 3O- 3V. 4.4 40O 53G 5GY 5VS 7X7 7~S 88E 88I 8AF 8F7 8FE 8FH 8FI 8FJ 8R4 8R5 AAHLL AAKAS AAOJX AAUVZ AAWJN AAYEP ABAAH ABJNI ABKDF ABMQD ABOCM ABTFR ABUWG ABVAJ ACGFO ACGFS ACGOD ACGTL ACHTP ACMFJ ACOFX ACTZY ADBBV ADCEG ADFRT ADUGQ ADZCM AENEX AFKRA AFWFF AHMBA AHNKE AHQMW AI. AJYBZ ALIPV ALMA_UNASSIGNED_HOLDINGS ASPBG AVWKF AZFZN AZQEC BAWUL BBNVY BENPR BHPHI BLJBA BOMFT BPHCQ BTFSW BTHHO BVXVI C1A C45 CAG CCPQU COF CS3 CXRWF DIK DU5 DWQXO E3Z EBS EJD F5P FD8 FEDTE FYUFA GNUQQ GX1 H13 HAJ HCIFZ HMCUK HVGLF HYE HZ~ IAO IEA IH2 IHR INH INR IOF ITC J5H KQ8 L7B LK8 M1P M2P M7P N9A NTWIH NXWIF O9- OK1 OVD P2P PQQKQ PROAC PSQYO Q2X R53 RHF RHI RMJ RPM RV8 TEORI TR2 UKHRP UYXKK V24 VH1 VM9 VVN W8F WH7 WOQ X7M YFH YOC YQY ZGI ZXP ZY1 8RD ABPTK AEQTP BHJZB BJGMD BSCLL ZA5 AAYXX CITATION 7XB 8FK K9. PQEST PQUKI PRINS Q9U 7T5 7U9 H94 |
ID | FETCH-LOGICAL-b2263-f965ada31d1c34502f334f37dfe623fa97ac4afb06db77dec58ebf20c4a547853 |
IEDL.DBID | BENPR |
ISSN | 0017-5749 |
IngestDate | Fri Aug 16 08:34:28 EDT 2024 Thu Oct 10 17:24:05 EDT 2024 Fri Aug 23 00:45:55 EDT 2024 Wed Jan 17 04:51:43 EST 2024 Wed Aug 21 03:28:51 EDT 2024 |
IsDoiOpenAccess | false |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | Suppl 1 |
Language | English |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-b2263-f965ada31d1c34502f334f37dfe623fa97ac4afb06db77dec58ebf20c4a547853 |
Notes | ark:/67375/NVC-SB9N76DW-S local:gutjnl;60/Suppl_1/A229-a ArticleID:gutjnl239301.483 href:gutjnl-60-A229-1.pdf istex:797DF5492CC40CEACBFCBE5224625D144FBF9278 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 |
OpenAccessLink | https://gut.bmj.com/content/gutjnl/60/Suppl_1/A229.1.full.pdf |
PQID | 2038733720 |
PQPubID | 2041069 |
ParticipantIDs | proquest_miscellaneous_907156654 proquest_journals_2038733720 crossref_primary_10_1136_gut_2011_239301_483 istex_primary_ark_67375_NVC_SB9N76DW_S bmj_primary_10_1136_gut_2011_239301_483 |
PublicationCentury | 2000 |
PublicationDate | 20110401 |
PublicationDateYYYYMMDD | 2011-04-01 |
PublicationDate_xml | – month: 04 year: 2011 text: 20110401 day: 01 |
PublicationDecade | 2010 |
PublicationPlace | London |
PublicationPlace_xml | – name: London |
PublicationTitle | Gut |
PublicationTitleAlternate | Gut |
PublicationYear | 2011 |
Publisher | BMJ Publishing Group Ltd and British Society of Gastroenterology BMJ Publishing Group LTD |
Publisher_xml | – name: BMJ Publishing Group Ltd and British Society of Gastroenterology – name: BMJ Publishing Group LTD |
References | Hoeroldt 2009; 58 Luth 2008; 42 |
References_xml | – volume: 58 start-page: A18 year: 2009 publication-title: Gut contributor: fullname: Hoeroldt – volume: 42 start-page: 926 year: 2008 publication-title: J Clin Gastroenterol contributor: fullname: Luth |
SSID | ssj0008891 |
Score | 2.0393548 |
Snippet | Introduction The authors have reported1 that following immunosuppressive treatment of Autoimmune Hepatitis (AIH), many patients fail to achieve histological... Introduction The authors have reported 1 that following immunosuppressive treatment of Autoimmune Hepatitis (AIH), many patients fail to achieve histological... INTRODUCTION: The authors have reported1 that following immunosuppressive treatment of Autoimmune Hepatitis (AIH), many patients fail to achieve histological... |
SourceID | proquest crossref istex bmj |
SourceType | Aggregation Database Publisher |
StartPage | A229 |
SubjectTerms | Age autoimmune hepatitis Azathioprine Biopsy Digestive tract Fibrosis Hepatitis Inflammation Liver transplantation Patients Prednisolone Remission Survival |
Title | Treatment of autoimmune hepatitis: what is the optimal end point on follow-up biopsy? |
URI | http://dx.doi.org/10.1136/gut.2011.239301.483 https://api.istex.fr/ark:/67375/NVC-SB9N76DW-S/fulltext.pdf https://www.proquest.com/docview/2038733720 https://search.proquest.com/docview/907156654 |
Volume | 60 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1Lb9QwELZoV0JcKp5iaal8QHAhkKxfCZeKllYVUleIdmFvlh3bNKDGoUlU-PeME2cRQkJcE8eHz-N5fZMZhJ6VhLOM2zSxOdEJzVyaaLCSiaUQh5lUgYceGN2zJT9d0fdrto4JtzaWVU46cVDUxpchRw5BOskFCTNVDprvSZgaFdjVOEJjC80WGQ007ezwePnh40YX59PMPNDFTNAi9h3KCH_9pe_GDp6hCViavaJD50B99fUPCzULYP_4S1EP1ufkLtqJbiN-O57zPXTL1vfR7bNIjD9Aq4upYBx7h1Xf-Sr8-GHxpQ0l013VvsE3l6rDVYvB5cMeNMUVbGhrgxtfhc9q7EAm_E3SN1hXvml_HjxEq5Pji6PTJE5MAIAXnCSu4EwZRTKTlYSydOEIoY4I4yy4OU4VQpVUOZ1yo4UwtmS51W6RwsPQ14uRR2i79rV9jLAggZI2nFvjqOK60EWeg_EipuS2VHSOXgBWshl7YsghliBcAqoyoCpHVCWgOkcvJzz_b_nzAfPNWnX9LVSfCSaXn47k-WGxFPzdZ3k-R3vToch48Vr5W0zmCG9ew5UJPIiqre9bWYBbxcLU5Sf_3mEX3RkzyKFOZw9td9e9fQouSKf30ZZYi_0obb8ASa_XPA |
link.rule.ids | 315,786,790,12083,21416,27955,27956,31752,31753,33777,33778,43343,43838,74100,74657 |
linkProvider | ProQuest |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1Lb9QwELaglYAL4im2D_ABwYVAsnbshEsFhWqB7l66C3uz7NimoWqSNokK_74zeSxCSIhr4vjweTzPLzOEPM-YiCPhwsAlzAQ88mFgwEoGjkMcZkMNHjpWdOcLMVvxz-t4PSTc6oFWOerETlHbMsMcOQTpLJEMZ6ocVBcBTo3C6uowQuMm2eaMcZRzud4EXMjgiUZNHEueDl2HIibefG-bvn8ntgALo9e86xtozn_8YZ-2Eeqff6npzvYc3SN3B6eRvutP-T654YoH5NZ8KIs_JKvlSBenpae6bcocf_tw9NQhYbrJ67f06lQ3NK8pOHy0BD1xDhu6wtKqzPGzgnqQiPIqaCtq8rKqfx08Iqujj8vDWTDMSwB4p4IFPhWxtppFNsoYj8OpB0w8k9Y7cHK8TqXOuPYmFNZIaV0WJ874aQgPsatXzB6TraIs3BNCJcOCtBXCWc-1MKlJkwRMF7OZcJnmE_ISsFJV3xFDdZEEEwpQVYiq6lFVgOqEvBrx_L_lLzrMN2v15Rlyz2SsFl8P1cn7dCHFh2_qZEL2xkNRw7Wr1W8hmRC6eQ0XBqsgunBlW6sUnKoYZy7v_HuHZ-T2bDk_VsefFl92yZ0-l4yMnT2y1Vy2bh-ckcY87STuGsWI19w |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1Lb9QwELaglSouiKdYKOADgguhyfqVcKmgZVUeXSG1C3uz7NimATUJTaLCv2cmj0UICXG1HR8-j-fh-TJDyJOcSZFIH0c-ZTbiSYgjC1Yy8hziMBcb8NAxo3u8lEcr_m4t1iP_qRlplZNO7BW1q3J8I4cgnaWKYU-VvTDSIj4eLvbr7xF2kMJM69hO4yrZBisZYxsHtd4EX8jmSSatLBTPxgpECZN7X7p2qOWJ5cDi5AXvawja869_2KpthP3HXyq7t0OLG-T66EDSV8OJ3yRXfHmL7ByPKfLbZHU6UcdpFajp2qrAX0A8PfNInm6L5iW9PDMtLRoKzh-tQGecw4a-dLSuCvyspAGko7qMupraoqqbn_t3yGrx5vTgKBp7JwDUc8mikElhnGGJS3LGRTwPjPHAlAseHJ5gMmVyboKNpbNKOZ-L1Nswj2EQK3wJdpdslVXp7xGqGCannZTeBW6kzWyWpmDGmMulzw2fkWeAla6H6hi6jyqY1ICqRlT1gKoGVGfk-YTn_y1_2mO-WWsuviEPTQm9_HSgT15nSyUPP-uTGdmdDkWPV7DRvwVmRuhmGi4PZkRM6auu0Rk4WAL7L9__9w6PyQ4Im_7wdvn-Abk2PCsjeWeXbLUXnX8IfklrH_UC9wvwCdwI |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Treatment+of+autoimmune+hepatitis%3A+what+is+the+optimal+end+point+on+follow-up+biopsy%3F&rft.jtitle=Gut&rft.au=Dhaliwal%2C+H.+K.&rft.au=Hoeroldt%2C+B.+S.&rft.au=Dube%2C+A.&rft.au=McFarlane%2C+E.&rft.date=2011-04-01&rft.issn=0017-5749&rft.volume=60&rft.issue=Suppl+1&rft.spage=A229&rft.epage=A229&rft_id=info:doi/10.1136%2Fgut.2011.239301.483&rft.externalDBID=n%2Fa&rft.externalDocID=10_1136_gut_2011_239301_483 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0017-5749&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0017-5749&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0017-5749&client=summon |