AUTOIMMUNE HEPATITIS: DIAGNOSTIC CHALLENGES AND RISK FACTORS – A NARRATIVE REVIEW

Marta Góral; Katarzyna Bednarczuk; Aleksandra Irena Skuza; Magda Downar-Zapolska; Katarzyna Helena Sergiel; Emilia Torbacka; Dominik Fidorowicz; Daniel Sagan; Rafał Siedlecki; Agnieszka Mikłaszewicz

doi:10.31435/ijitss.2(50).2026.5373

Authors

Marta Góral Independent Public Provincial Integrated Hospital in Szczecin – Zdunowo, Szczecin, Poland https://orcid.org/0009-0004-1063-897X
Katarzyna Bednarczuk Independent Public Provincial Integrated Hospital in Szczecin – Arkońska, Szczecin, Poland https://orcid.org/0009-0000-5207-6718
Aleksandra Irena Skuza Independent Public Provincial Integrated Hospital in Szczecin – Arkońska, Szczecin, Poland https://orcid.org/0009-0000-3071-2015
Magda Downar-Zapolska Independent Public Provincial Integrated Hospital in Szczecin – Arkońska, Szczecin, Poland https://orcid.org/0009-0008-4646-0404
Katarzyna Helena Sergiel Independent Public Provincial Integrated Hospital in Szczecin – Arkońska, Szczecin, Poland https://orcid.org/0009-0002-6627-9852
Emilia Torbacka University Clinical Hospital No. 2 in Szczecin, Szczecin, Poland https://orcid.org/0009-0001-4624-3564
Dominik Fidorowicz Independent Public Provincial Integrated Hospital in Szczecin – Arkońska, Szczecin, Poland https://orcid.org/0009-0005-2184-4004
Daniel Sagan Independent Public Provincial Integrated Hospital in Szczecin – Arkońska, Szczecin, Poland https://orcid.org/0009-0007-8247-9842
Rafał Siedlecki Independent Public Provincial Integrated Hospital in Szczecin – Zdunowo, Szczecin, Poland https://orcid.org/0009-0005-2653-2368
Agnieszka Mikłaszewicz University Clinical Hospital No. 1 in Szczecin, Szczecin, Poland https://orcid.org/0009-0007-7423-6103

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5373

Keywords:

Autoimmune Hepatitis, Diagnosis, Histopathology, Autoantibodies, Risk Factors, Liver Disease

Abstract

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease of unclear etiology, characterized by loss of immune tolerance to hepatocyte antigens in genetically predisposed individuals. Despite global occurrence and increasing prevalence, no uniform pattern of environmental triggers or genetic susceptibility has been established. Clinically, AIH demonstrates marked heterogeneity, ranging from asymptomatic biochemical abnormalities to acute liver failure or advanced cirrhosis at presentation, posing significant diagnostic challenges.

Diagnosis relies on a combination of serological, biochemical, and histopathological findings. Although autoantibodies and elevated immunoglobulin G levels remain key diagnostic markers, their limited specificity and occasional absence—particularly in acute presentations—complicate clinical assessment. Liver biopsy continues to play a central role in diagnosis, disease staging, and therapeutic decision-making, despite the growing availability of noninvasive methods. Histopathological features such as interface hepatitis, plasma cell infiltration, and lobular inflammation support the diagnosis but are not pathognomonic.

The pathogenesis of AIH involves complex immune dysregulation, including T-cell–mediated responses, impaired regulatory mechanisms, and aberrant antigen presentation. Emerging evidence highlights the potential contribution of intestinal barrier dysfunction and gut microbiota alterations to disease development and progression, although the underlying mechanisms remain incompletely understood.

Genetic predisposition, particularly within the HLA region, along with female sex and age-related factors, contribute to disease susceptibility. Additionally, AIH may coexist with other autoimmune conditions, further complicating its clinical course and diagnosis.

In summary, AIH remains a diagnostically challenging and clinically diverse disease requiring a multidisciplinary approach. Advances in immunology, histopathology, and microbiome research may improve understanding of disease mechanisms and facilitate the development of more precise diagnostic and therapeutic strategies.

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