title: The hepatitic/cholestatic "overlap" syndrome: an Italian experience.
abstract: BACKGROUND
  Patients with hepatitic and cholestatic autoimmune liver disease ("overlap syndrome") represent a diagnostic and therapeutic challenge.
  
  
  OBJECTIVE
  To evaluate the prevalence of the "hepatitic/cholestatic overlap" in a large series of consecutive patients with cholestatic autoimmune liver disease.
  
  
  METHODS
  We re-evaluated the diagnosis of 235 patients with autoimmune liver disease, including 70 with type 1 autoimmune hepatitis (AIH), 142 with primary biliary cirrhosis (PBC), and 23 with primary sclerosing cholangitis (PSC), using the revised International Autoimmune Hepatitis Group (IAIHG) scoring system. Anti-mitochondrial, anti-nuclear, anti-smooth muscle, anti-liver kidney microsomal type 1, anti-liver cytosol type 1, perinuclear anti-neutrophil nuclear and anti-soluble liver antigen antibodies were evaluated in each patient.
  
  
  RESULTS
  Ten patients (3 with a previous diagnosis of PBC and 7 of PSC) scored as "probable" or "definite" AIH. These patients did not have a specific autoantibody profile.
  
  
  CONCLUSIONS
  Among patients with PBC, the occurrence of a PBC/AIH overlapping syndrome is rare (2.1%), whereas among patients with PSC an overlap between PSC and AIH is frequent (30.4%). Whether patients with the hepatitic/cholestatic overlap syndrome would benefit from a combination therapy with immunosuppression and ursodeoxycholic acid remains to be established.
authors.affiliation: Department of Internal Medicine, Cardioangiology, Hepatology, Alma Mater Studiorum, University of Bologna, Policlinico Sant'Orsola-Malpighi, via Massarni, 9, 40138, Bologna Italy. muratori@med.unibo.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Muratori
authors.forename: Fabio
authors.initials: F
authors.lastname: Cassani
authors.forename: Georgios
authors.initials: G
authors.lastname: Pappas
authors.forename: Marcello
authors.initials: M
authors.lastname: Guidi
authors.forename: Loredana
authors.initials: L
authors.lastname: Mele
authors.forename: Veronesi
authors.initials: V
authors.lastname: Lorenza
authors.forename: Marco
authors.initials: M
authors.lastname: Lenzi
authors.forename: Francesco B
authors.initials: FB
authors.lastname: Bianchi
authors.forename: Paolo
authors.initials: P
authors.lastname: Muratori
mesh_terms: D001323:Autoantibodies / Q000276:immunology*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000276:immunology*; D006801:Humans; D007558:Italy; D008105:Liver Cirrhosis, Biliary / Q000276:immunology*; D008297:Male
chemical_list: D001323:Autoantibodies