Original Article

Evaluation of Histological Criteria and Immunoserological Testing of Simplified Criteria for the Diagnosis of Autoimmune Hepatitis

Volume 37 · Issue 2 Publish Date: September 18, 2025
Kenan Moral ORCID Cumali Efe ORCID Ayşenur Sert ORCID Berkay Şimşek ORCID Dilara Turan Gökçe ORCID Nergiz Ekmen ORCID Ersin Batıbay ORCID Murat Kekilli ORCID Tarkan Karakan ORCID Mehmet Ibiş ORCID Güner Kiliç ORCID Ersan Ozaslan ORCID Haluk Cihad Albayrak ORCID Veysel Baran Tomar Derya Arı ORCID Dilek Yapar ORCID Meral Akdoğan ORCID Mehmet Cindoruk Staffan Wahlin ORCID Guldal Esendagli ORCID Nesrin Turhan ORCID Gulen Akyol ORCID
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Turkish Journal of Gastroenterology

Volume 37 · Issue 2

Pages: 223-232

History

Published Online: September 18, 2025

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright © 2025 Kenan Moral, Cumali Efe, Ayşenur Sert, Berkay Şimşek, Dilara Turan Gökçe, Nergiz Ekmen, Ersin Batıbay, Murat Kekilli, Tarkan Karakan, Mehmet Ibiş, Güner Kiliç, Ersan Ozaslan, Haluk Cihad Albayrak, Veysel Baran Tomar, Derya Arı, Dilek Yapar, Meral Akdoğan, Mehmet Cindoruk, Staffan Wahlin, Guldal Esendagli, Nesrin Turhan, Gulen Akyol

Kenan Moral ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Cumali Efe ORCID
Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Türkiye
Ayşenur Sert ORCID
Department of Pathology, Gazi University School of Medicine, Ankara, Türkiye
Berkay Şimşek ORCID
Department of Pathology, Gazi University School of Medicine, Ankara, Türkiye
Dilara Turan Gökçe ORCID
Department of Gastroenterology, Sincan State Hospital, Ankara, Türkiye
Nergiz Ekmen ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Ersin Batıbay ORCID
Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Türkiye
Murat Kekilli ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Tarkan Karakan ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Mehmet Ibiş ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Güner Kiliç ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Ersan Ozaslan ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Türkiye
Haluk Cihad Albayrak ORCID
Department of Internal Medicine, Gazi University School of Medicine, Ankara, Türkiye
Veysel Baran Tomar
Department of Internal Medicine, Gazi University School of Medicine, Ankara, Türkiye
Derya Arı ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Türkiye
Dilek Yapar ORCID
Institute of Health Science, Department of Medical Informatics, Akdeniz University, Antalya, Türkiye
Meral Akdoğan ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Türkiy
Mehmet Cindoruk
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Staffan Wahlin ORCID
Division of Hepatology, Department of Upper GI Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Guldal Esendagli ORCID
Department of Pathology, Gazi University School of Medicine, Ankara, Türkiye
Nesrin Turhan ORCID
Department of Pathology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Türkiye
Gulen Akyol ORCID
Department of Pathology, Gazi University School of Medicine, Ankara, Türkiye
Moral, K., Efe, C., Sert, A., Şimşek, B., Gökçe, D. T., Ekmen, N., … Akyol, G. (2025). Evaluation of Histological Criteria and Immunoserological Testing of Simplified Criteria for the Diagnosis of Autoimmune Hepatitis. Turkish Journal of Gastroenterology, 37(2), 223–232. https://doi.org/10.5152/tjg.2025.25402
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Abstract

Background/Aims: The International Autoimmune Hepatitis (AIH) Group recommends the new histological criteria (HC) (2022) and modified immunoserological testing for diagnosing AIH. The diagnostic utility of the 2022 HC was evaluated. The simplified criteria were also updated with the 2022 HC and immunoserological testing and assessed the diagnostic performance.

Materials and Methods: The data of 207 patients (111 AIH, 33 primary biliary cholangitis, 35 drug-induced liver injury, and 28 metabolic dysfunction–associated fatty liver disease) were evaluated.

Results: The 2022 HC and the 2008 simplified HC showed 95% vs. 88% sensitivity and 82% vs. 49% specificity for possible/compatible AIH. For likely/typical AIH, sensitivity was 60% vs. 42% and specificity was 98% vs. 95% for the 2022 HC and the 2008 HC, respectively.
The area under the curve (AUC) was better for the 2022 HC than for the 2008 simplified HC (0.932 vs. 0.771, P < .001). The updated simplified criteria had a sensitivity comparable with the simplified criteria (88% vs. 87%) but a better specificity (94% vs. 80%) for prob able AIH. The sensitivity was slightly lower (57% vs. 63%), but the specificity was greater (97% vs. 89%) for definitive AIH. The AUC was higher in the updated simplified criteria than in the simplified criteria (0.959 vs. 0.894, P = .016).

Conclusion: The 2022 HC showed better sensitivity and specificity than the 2008 simplified HC for AIH. The updated simplified criteria worked well with improved accuracy of AIH diagnosis. Our results suggest that the diagnostic algorithm of AIH should be modified based on recent recommendations.

 

Cite this article as: Moral K, Efe C, Sert A, et al. Evaluation of histological criteria and immunoserological testing of simplified criteria for the diagnosis of autoimmune hepatitis. Turk J Gastroenterol. 2026;37(2):223-232.

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Article Info
Published In
Journal Turkish Journal of Gastroenterology
Volume / Issue Volume 37 · Issue 2
Pages 223-232
DOI 10.5152/tjg.2025.25402
History
Published Online September 18, 2025
License
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright
Copyright (c) 2025 Kenan Moral, Cumali Efe, Ayşenur Sert, Berkay Şimşek, Dilara Turan Gökçe, Nergiz Ekmen, Ersin Batıbay, Murat Kekilli, Tarkan Karakan, Mehmet Ibiş, Güner Kiliç, Ersan Ozaslan, Haluk Cihad Albayrak, Veysel Baran Tomar, Derya Arı, Dilek Yapar, Meral Akdoğan, Mehmet Cindoruk, Staffan Wahlin, Guldal Esendagli, Nesrin Turhan, Gulen Akyol
Affiliations
Kenan Moral ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Cumali Efe ORCID
Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Türkiye
Ayşenur Sert ORCID
Department of Pathology, Gazi University School of Medicine, Ankara, Türkiye
Berkay Şimşek ORCID
Department of Pathology, Gazi University School of Medicine, Ankara, Türkiye
Dilara Turan Gökçe ORCID
Department of Gastroenterology, Sincan State Hospital, Ankara, Türkiye
Nergiz Ekmen ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Ersin Batıbay ORCID
Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Türkiye
Murat Kekilli ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Tarkan Karakan ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Mehmet Ibiş ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Güner Kiliç ORCID
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Ersan Ozaslan ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Türkiye
Haluk Cihad Albayrak ORCID
Department of Internal Medicine, Gazi University School of Medicine, Ankara, Türkiye
Veysel Baran Tomar
Department of Internal Medicine, Gazi University School of Medicine, Ankara, Türkiye
Derya Arı ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Türkiye
Dilek Yapar ORCID
Institute of Health Science, Department of Medical Informatics, Akdeniz University, Antalya, Türkiye
Meral Akdoğan ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Türkiy
Mehmet Cindoruk
Department of Gastroenterology and Hepatology, Gazi University School of Medicine, Ankara, Türkiye
Staffan Wahlin ORCID
Division of Hepatology, Department of Upper GI Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Guldal Esendagli ORCID
Department of Pathology, Gazi University School of Medicine, Ankara, Türkiye
Nesrin Turhan ORCID
Department of Pathology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Türkiye
Gulen Akyol ORCID
Department of Pathology, Gazi University School of Medicine, Ankara, Türkiye
Cite this Article
Moral, K., Efe, C., Sert, A., Şimşek, B., Gökçe, D. T., Ekmen, N., … Akyol, G. (2025). Evaluation of Histological Criteria and Immunoserological Testing of Simplified Criteria for the Diagnosis of Autoimmune Hepatitis. Turkish Journal of Gastroenterology, 37(2), 223–232. https://doi.org/10.5152/tjg.2025.25402
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