title: Diagnosis and management of overlap syndromes.
abstract: Overlapping features between autoimmune hepatitis (AIH) and cholestatic disorders (primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), or indeterminate cholestasis), so-called overlap syndromes, usually have a progressive course toward cirrhosis and liver failure without adequate treatment. The diagnosis of overlap syndrome requires the prominent features of classic AIH and secondary objective findings of PBC or PSC. Empiric treatment for patients with AIH-PBC overlap is immunosuppressive therapy plus ursodeoxycholic acid. Empiric treatment for patients with AIH-PSC and AIH-cholestatic overlap is immunosuppressive therapy with or without ursodeoxycholic acid. Liver transplantation is indicated for patients who have end-stage liver disease.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand.
authors.forename: Chalermrat
authors.initials: C
authors.lastname: Bunchorntavakul
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address: rajender.reddy@uphs.upenn.edu.
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
mesh_terms: D001323:Autoantibodies / Q000097:blood; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D015209:Cholangitis, Sclerosing / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D003937:Diagnosis, Differential; D018450:Disease Progression; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D016031:Liver Transplantation; D013577:Syndrome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D001323:Autoantibodies; D002756:Cholagogues and Choleretics; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D014580:Ursodeoxycholic Acid
keywords: Autoimmune cholangitis; Autoimmune hepatitis; Autoimmune liver disease; Management; Overlap syndrome; Primary biliary cirrhosis; Primary sclerosing cholangitis