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Inicio Annals of Hepatology P-38 CRYPTOGENIC CHRONIC HEPATITIS: LOOKING FOR AN ETIOLOGICAL DIAGNOSIS
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Vol. 28. Núm. S1.
Abstracts of the 2022 Annual Meeting of the ALEH
(marzo 2023)
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Vol. 28. Núm. S1.
Abstracts of the 2022 Annual Meeting of the ALEH
(marzo 2023)
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P-38 CRYPTOGENIC CHRONIC HEPATITIS: LOOKING FOR AN ETIOLOGICAL DIAGNOSIS
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Guilherme Cançado Grossi Lopes1, Aline Candolo Coelho Rocha2, Jorge Nardelli Mateus1, Patricia Zitelli Momoyo2, Daniel Mazo Ferraz De Campos2,3, Claudia Oliveira Pinto Marques De Souza2, Marlone Cunha-Silva3, Raquel Greca Dias3, Roberta Araújo Chaves4, Amanda Sacha Alustau Paulino Tolentino4, Claudia Couto Alves1, Roque Gabriel Rezende De Lima2, Alberto Farias Queiroz2, Flair José Carrilho2, Mário Guimarães Pessôa2
1 Gastroenterology Alfa Institute, Clinics Hospital, Minas Gerais Federal University (UFMG), Belo Horizonte, Brazil
2 Division of Clinical Gastroenterology and Hepatology, Department of Gastroenterology, Clinics Hospital, São Paulo University (HCFMUSP), São Paulo, Brazil
3 Division of Gastroenterology (Gastrocentro), School of Medical Sciences, Campinas State University (UNICAMP), Campinas, Brazil
4 Gastroenterology Division, Medical School Ribeirão Preto, São Paulo - Ribeirão Preto University (FMRP- USP), Ribeirão Preto, Brazil
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Vol. 28. Núm S1

Abstracts of the 2022 Annual Meeting of the ALEH

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Introduction and Objectives

Cryptogenic chronic hepatitis is an increasing cause of liver transplantation and affects 5-15% of patients with chronic liver diseases. This study aimed to investigate possible underlying causes of presumed cryptogenic liver disease referred to specialized liver centers by general practitioners in Brazil and to propose a new diagnostic algorithm including metabolic-dysfunction-associated fatty liver disease (MAFLD) definition and lysosomal acid lipase deficiency (LAL-D) investigation.

Materials and Methods

A retrospective multicentric Brazilian cohort of patients with presumed chronic cryptogenic hepatitis was reanalyzed with respect to their clinical, laboratory and histological data using Czaja´s algorithm (2011).

Results

326 patients [mean age 60 (46-68) years, 42.9% males] were initially included, 35.7% with cirrhosis. Forty-five individuals were excluded due to an incomplete etiological investigation. Using Czaja´s algorithm, diagnosis of nonalcoholic fatty liver disease could be established in 60 patients (21.3%), alpha-1-antitrypsin deficiency in 9 (3.2%), alcoholic liver disease in 7 (2.7%), autoimmune hepatitis in 5 (1.78%), hemochromatosis in 5 (1.78%), biliary-related hepatitis in 4 (1.4%), viral hepatitis in 4 (1.4%), Budd Chiari in 4 (1.4%), glycogenosis in 3 (1%), drug-induced liver injury in 2 (0.7%), and Wilson disease in 1 (0.35%). LAL-D was demonstrated in 3 individuals (1%). One hundred seventy-five patients remained with cryptogenic hepatitis (53.6%) (FIGURE A). During follow-up, 40 of those patients were submitted to liver transplantation and 19 (47.5%) were retrospectively diagnosed with non-alcoholic steatohepatitis after histopathological examination of the explanted liver. By including MAFLD in the first step of the new algorithm, 100 patients would have been diagnosed (34.9%), reducing the number of individuals without a diagnosis by 18.3% (FIGURE B).

Conclusions

One-third of patients with initially presumed cryptogenic liver disease were diagnosed with MAFLD. Despite being a rare disease, LAL-D investigation should be considered for individuals with chronic liver disease of unknown etiology. An updated diagnostic algorithm is proposed for those individuals.

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