caa a22 4500 44579464X CHVBK 20180317145120.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1007/s10620-011-1769-9 doi (NATIONALLICENCE)springer-10.1007/s10620-011-1769-9 Czaja Albert Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street S.W., 55905, Rochester, MN, USA aut Cryptogenic Chronic Hepatitis and Its Changing Guise in Adults [Elektronische Daten] [Albert Czaja] Cryptogenic chronic hepatitis is a disease that is unexplained by conventional clinical, laboratory and histological findings, and it can progress to cirrhosis, develop hepatocellular carcinoma, and require liver transplantation. The goals of this review are to describe the changing phenotype of cryptogenic chronic hepatitis in adults, develop a diagnostic algorithm appropriate to current practice, and suggest treatment options. The frequency of cryptogenic hepatitis is estimated at 5.4%. Cryptogenic cirrhosis is diagnosed in 5-30% of patients with cirrhosis, and it is present in 3-14% of adults awaiting liver transplantation. Nonalcoholic fatty liver disease has been implicated in 21-63% of patients, and autoimmune hepatitis is a likely diagnosis in 10-54% of individuals. Viral infections, hereditary liver diseases, celiac disease, and unsuspected alcohol or drug-induced liver injury are recognized infrequently in the current cryptogenic population. Manifestations of the metabolic syndrome heighten the suspicion of nonalcoholic fatty liver disease, and the absence of hepatic steatosis does not discount this possibility. The diagnostic scoring system of the International Autoimmune Hepatitis Group can support the diagnosis of autoimmune hepatitis in some patients. Certain genetic mutations may have disease-specificity, and they suggest that some patients may have an independent and uncharacterized disease. Corticosteroid therapy is effective in patients with autoimmune features, and life-style changes and specific therapies for manifestations of the metabolic syndrome are appropriate for all obese patients. The 1- and 5-year survivals after liver transplantation have ranged from 72-85% to 58-73%, respectively. Springer Science+Business Media, LLC, 2011 Cryptogenic hepatitis nationallicence Autoantibody-negative nationallicence Chronic hepatitis nationallicence Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/12(2011-12-01), 3421-3438 0163-2116 56:12<3421 2011 56 10620 https://doi.org/10.1007/s10620-011-1769-9 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-011-1769-9 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Czaja Albert Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street S.W., 55905, Rochester, MN, USA aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/12(2011-12-01), 3421-3438 0163-2116 56:12<3421 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer