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Summary: Background: Sequential use of non‐invasive fibrosis tests (NITs) to identify patients with advanced hepatic fibrosis is recommended. However, it remains unclear how reliable clinicians are staging liver fibrosis using combinations of NITs. Aim: Our aim was to assess concordance between NIT‐based 'clinician fibrosis assessment (CFA)' and histology in patients with metabolic dysfunction‐associated steatotic liver disease (MASLD) and compare this with established algorithmic approaches. Methods: Six experienced hepatologists independently staged 230 MASLD patients for advanced fibrosis (F0‐2 vs F3‐4) using FIB‐4, FIB‐4+ELF, FIB‐4+ vibration controlled transient elastography (VCTE; Fibroscan™) and FIB‐4+ELF+VTCE. Concordance between histology and CFA or algorithmic approaches were assessed. Results: A total of 230 patients were included (median age 54 [22–78] years; 55% female; median FIB‐4 1.21 [IQR: 0.78–1.91]; ELF 9.3 [IQR: 8.6–10.2]; VCTE 9.4 [IQR: 6.3–14.3]; 41% F0‐1, 22% F2, 21% F3 and 16% F4). Overall, area under the receiver operator curves for histologic F3‐4 for the raw tests were 0.84 for FIB‐4, 0.86 for ELF and 0.86 for VCTE. Concordance between the hepatologists was good (FIB4, κ = 0.64; FIB‐4+ELF, κ = 0.70; FIB‐4+VCTE, κ = 0.69; FIB‐4+ELF+VCTE, κ = 0.70). Concordance between individual CFA and histology was variable, which was reflected in variability in sensitivity (44%–84%) and specificity (76%–94%). Concordance with histology was better when clinicians used NIT combinations. Purely algorithmic approaches, particularly sequential use of FIB‐4 then VCTE, tended to perform better than the CFA. Conclusions: Adhering to the recommended algorithmic approaches using NITs to stage fibrosis tended to perform more accurately than less‐structured clinician NIT‐based assessments conducted by experienced hepatologists. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to McPherson et al papers. To view these articles, visit https://doi.org/10.1111/apt.18061 and https://doi.org/10.1111/apt.18176 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to McPherson et al papers. To view these articles, visit https://doi.org/10.1111/apt.18061 and https://doi.org/10.1111/apt.18171. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that results in substantial morbidity and mortality with many unanswered clinical and research questions. Improved understanding of disease pathogenesis, including the extra‐hepatic manifestations of AIH, may allow targeted treatments with greater efficacy and fewer associated adverse events. Aim: To identify the spectrum of unanswered clinical and research questions facing care providers in the management of patients with autoimmune hepatitis (AIH). Methods: The International Autoimmune Hepatitis Group initiated a series of research workshops to start to address these questions. Key issues were discussed in small group sessions with collation of all discussions to be summarised in this manuscript. Results: Key issues were identified as: the need for better understanding of disease pathogenesis, standardisation of the methods and assays used to evaluate autoantibodies in AIH, refinement of the histopathological criteria for "typical" or "compatible" AIH, focus on the interaction with non‐alcohol related fatty liver disease, how to treat acute severe AIH, better assessment of quality of life in adults and paediatrics, standardising use of standard, third‐line and experimental therapies in AIH and search for biomarkers early in the disease course that predict outcome. Conclusion: This workshop has outlined the key unanswered clinical and research questions to help to define the research agenda in AIH. [ABSTRACT FROM AUTHOR]

Summary: Background: Treatment paradigms in autoimmune hepatitis (AIH) have remained largely unchanged for decades. Studies report ≤20% of patients have sub‐optimal treatment response with most requiring long‐term therapy. Aim: The United Kingdom Autoimmune Hepatitis (UK‐AIH) study was established to evaluate current treatment practice and outcomes, determine the unmet needs of patients, and develop and implement improved treatment approaches. Methods: The United Kingdom Autoimmune Hepatitis study is a cross‐sectional cohort study examining secondary care management of prevalent adult patients with a clinical diagnosis of autoimmune hepatitis. Enrolment began in March 2014. Prevalent cases were defined as having been diagnosed and treated for >1 year. Demographic data, biochemistry, treatment history and response, and care location were collected. Results: In total, 1249 patients were recruited; 635 were cared for in transplant units and 614 in non‐transplant centres (81% female with median age at diagnosis 50 years). Overall, 29 treatment regimens were reported and biochemical remission rate was 59%. Remission rates were significantly higher in transplant compared to non‐transplant centres (62 vs 55%, P = 0.028). 55% have ongoing corticosteroid exposure; 9% are receiving prednisolone monotherapy. Those aged ≤20 years at diagnosis were more likely to develop cirrhosis and place of care was associated with an aggressive disease phenotype. Conclusions: There are significant discrepancies in the care received by patients with autoimmune hepatitis in the UK. A high proportion remains on corticosteroids and there is significant treatment variability. Patients receiving care in transplant centres were more likely to achieve and maintain remission. Overall poor remission rates suggest that there are significant unmet therapeutic needs for patients with autoimmune hepatitis. [ABSTRACT FROM AUTHOR]

Background & Aims Patients with primary sclerosing cholangitis ( PSC) frequently highlight the impact of fatigue on their life quality. The study aims were to evaluate fatigue and its associations in PSC and investigate whether overt autonomic dysfunction contributes to the expression of fatigue. Methods All PSC patients under active follow-up at a regional liver centre were sent disease- and symptom-assessment tools. Three control groups were utilized; unselected community controls, patients with inflammatory bowel disease ( IBD) without PSC, and cholestatic controls with primary biliary cirrhosis ( PBC). A representative subgroup of PSC patients and normal controls underwent formal autonomic assessment. Results Symptom-assessment tools were returned by 40 non-transplanted patients. PSC patients had significantly worse fatigue than population controls ( P = 0.005). Fatigue was significant compared to population controls whether or not patients had accompanying IBD, although was more marked in those with both PSC and IBD. In patients with PSC and IBD, fatigue severity and autonomic symptoms were significantly increased in those with prior significant surgical intervention. Clinically significant autonomic dysfunction was seen in 22.5% of PSC patients, and of those, 78% had significant fatigue. Neurally mediated hypotension was found in 60% of PSC patients compared to 8% in the control group. The PSC group had increased sympathetic activity and reduced parasympathetic activity. Conclusion Fatigue is a significant problem in a minority of PSC patients and appears to be associated with autonomic dysfunction. Fatigued PSC patients should be screened for autonomic dysfunction and targeting such dysfunction represents a potential approach to treatment which warrants further exploration. [ABSTRACT FROM AUTHOR]