Autoimmune hepatitis in African Americans: presenting features and response to therapy.

OBJECTIVES: African Americans are at an increased risk for certain diseases and more frequently suffer complications of those diseases relative to their white counterparts. Most studies of autoimmune hepatitis consist of entirely white populations. The Emory University system of hospitals serves a large African American population, including a significant number of African Americans with autoimmune hepatitis. The goal of this study was to determine if the presentation and response to therapy in African Americans is, like other diseases, different than in whites. METHODS: This is a retrospective study from a tertiary referral center that examines the initial presenting features and response to therapy of African Americans (n = 27) and whites (n = 24) with autoimmune hepatitis. RESULTS: Eighty-five percent of African Americans had cirrhosis on the initial liver biopsy, as compared with 38% of whites. Although not statistically significant, the African Americans presented at an earlier age than white patients. The disease also appeared more advanced in African Americans, as bilibubin levels tended to be higher, but not significantly, and PTs were more prolonged. Both groups responded well to therapy, with significant falls in serum levels of AST, ALT, and bilirubin. Fifty percent of African Americans and 48% of whites entered a biochemical remission. The amount of prednisone required to maintain remission at follow-up was greater in African Americans. CONCLUSION: In contrast to whites, the majority of African Americans present with cirrhosis. Despite the high prevalence of cirrhosis, the response to therapy is good. However, more immunosuppression is required to control the disease in African Americans.

Evidence against flat dysplasia as a regional field defect in small bowel adenocarcinoma associated with celiac sprue.

OBJECTIVE: To determine whether diffuse flat dysplasia, akin to that seen with chronic ulcerative colitis, occurs as a mucosal field defect accompanying small bowel adenocarcinoma in patients with celiac sprue. DESIGN: A pathologic investigation of archival tissue was undertaken. MATERIAL AND METHODS: From the tissue archives at Mayo Clinic Rochester for the period from January 1978 to January 1993, resected sprue-associated adenocarcinomas with adequate adjacent mucosa for study were identified. On the basis of multiple strip biopsy specimens obtained at the tumor margins and within 4 cm distal and proximal to the tumor, histologic maps were created. RESULTS: Among 94 patients with primary adenocarcinoma of the small bowel, 8 had a concurrent diagnosis of celiac sprue. Of these eight cases, six surgically resected specimens (five duodenal and one jejunal adenocarcinoma) were adequate for study. A thin rim of benign dysplasia was demonstrated at the tumor margin in three of the six specimens; however, contiguous fields of flat dysplasia were not present in any of these cases. CONCLUSION: These data support focal dysplasia (for example, adenoma) rather than sheets of flat dysplasia as the premalignant lesion in sprue-associated small bowel adenocarcinoma. Blind endoscopic biopsies of small bowel mucosa are not justified for neoplasia surveillance in patients with celiac sprue.