Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2025; 17(7): 107881
Published online Jul 27, 2025. doi: 10.4254/wjh.v17.i7.107881
Toward non-invasive assessment strategies in autoimmune hepatitis
David Jerez Diaz, Patrick Twohig
David Jerez Diaz, Department of Internal Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, FL 34239, United States
Patrick Twohig, Department of Gastroenterology & Hepatology, University of Rochester Medical Center, Rochester, NY 14682, United States
Author contributions: Jerez Diaz D and Twohig P contributed to this paper. Twohig P designed the overall concept and outline of the manuscript; Diaz DJ contributed to the discussion and design of the manuscript. All authors both contributed to the writing, editing of the manuscript, and review of the literature.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Patrick Twohig, MD, MPH, Assistant Professor, FRCPC, Department of Gastroenterology & Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14682, United States. patrick_twohig@urmc.rochester.edu
Received: April 2, 2025
Revised: May 15, 2025
Accepted: July 1, 2025
Published online: July 27, 2025
Processing time: 117 Days and 4 Hours
Abstract

In this article, we comment on the article by Peta et al. This study evaluates the diagnostic performance of FibroTest-Actitest, transient elastography, and the fibrosis-4 index against a histological reference. Using the Obuchowski measure, the authors demonstrate that FibroTest and vibration-controlled transient elastography outperform the fibrosis-4 index in detecting fibrosis. Additionally, Actitest offers superior estimation of inflammatory activity compared to conventional biomarkers. Assessing liver fibrosis is crucial for managing autoimmune hepatitis (AIH), yet reliance on invasive liver biopsy remains higher than in other liver diseases. This is partly due to more complex diagnostic criteria for AIH, the lack of standardized scoring for non-invasive testing, and the presence of inflammation, which can lead to falsely elevated results with non-invasive tests. A Bayesian latent class model further supports the reliability of these non-invasive tests, highlighting their potential to complement biopsy, particularly for long-term disease monitoring. These findings underscore the importance of non-invasive diagnostics in optimizing AIH management.

Keywords: Autoimmune hepatitis; Non-invasive test; Liver biopsy; FibroTest; Actitest; Transient elastography; Fibrosis-4 index

Core Tip: This article reviews a study comparing non-invasive liver fibrosis tests in autoimmune hepatitis (AIH). FibroTest, transient elastography, and Actitest showed better accuracy than the fibrosis-4 index, with Actitest excelling in detecting inflammation. Although liver biopsy remains common in AIH due to diagnostic complexity and inflammation’s impact on non-invasive tests, a Bayesian model supports their reliability. The findings emphasize the value of non-invasive methods in improving long-term AIH monitoring and complementing liver biopsy.