nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-226-6-155-162nogr-2815Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSПерекрёстный синдром при болезнях печени у детей: клинический случай и обзор литературыOverlap syndrome in liver diseases in children: case report and literature reviewhttps://orcid.org/0000-0002-5413-9599ВолынецГ. В.VolynetsG. V.volynec_g@mail.ruСкворцоваТ. А.SkvortsovaT. A.noemail@neicon.ruНикитинА. В.NikitinA. V.noemail@neicon.ruhttps://orcid.org/0000-0001-7308-7280ХавкинА. И.KhavkinA. I.noemail@neicon.ruhttps://orcid.org/0000-0001-6926-3165ХасановаК. А.KhasanovaK. A.noemail@neicon.ruhttps://orcid.org/0000-0003-3537-6262КорочкинаЕ. С.KorochkinaE. S.noemail@neicon.ruhttps://orcid.org/0000-0001-6446-9201СкобеевД. А.SkobeevD. A.noemail@neicon.ruНаучно-исследовательский клинический институт педиатрии и детской хирургии имени академика Ю. Е. Вельтищева ФГАОУ ВО РНИМУ им. Н. И. Пирогова Минздрава России; Российский национальный исследовательский медицинский университет им. Н. И. Пирогова Минздрава РоссииРоссияVeltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University; Pirogov Russian National Research Medical UniversityRussian FederationНаучно-исследовательский клинический институт педиатрии и детской хирургии имени академика Ю. Е. Вельтищева ФГАОУ ВО РНИМУ им. Н. И. Пирогова Минздрава России; Морозовская детская городская клиническая больница Департамента здравоохранения г. МосквыРоссияVeltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University; Morozov Children’s City Clinical HospitalRussian FederationНаучно-исследовательский клинический институт детства Министерства здравоохранения Московской областиРоссияResearch Clinical Institute of Childhood, Ministry of Health of the Moscow RegionRussian FederationМорозовская детская городская клиническая больница Департамента здравоохранения г. Москвы; Первый МГМУ им. И. М. Сеченова Минздрава РоссииРоссияMorozov Children’s City Clinical Hospital; I. M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationМорозовская детская городская клиническая больница Департамента здравоохранения г. МосквыРоссияMorozov Children’s City Clinical HospitalRussian Federation20242210202406155162Copyright © Волынец Г.В., Скворцова Т.А., Никитин А.В., Хавкин А.И., Хасанова К.А., Корочкина Е.С., Скобеев Д.А., 20242024Волынец Г.В., Скворцова Т.А., Никитин А.В., Хавкин А.И., Хасанова К.А., Корочкина Е.С., Скобеев Д.А.Volynets G.V., Skvortsova T.A., Nikitin A.V., Khavkin A.I., Khasanova K.A., Korochkina E.S., Skobeev D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/2815

У детей аутоиммунные заболевания печени могут проявляться в самых разных формах, включая аутоиммунный гепатит (АИГ), первичный склерозирующий холангит (ПСХ) и одновременное присутствие АИГ и ПСХ - «перекрёстный синдром». Важно раннее распознавание перекрёстного синдрома. Диагностика склерозирующего холангита во многом зависит от холангиографической картины, показывающей одиночные или множественные стриктуры с расширением желчевыводящих путей. Показаны проблемы этиологии, патогенеза, диагностики и лечения перекрёстного синдрома у детей. Приводится клинический пример серонегативного аутоиммунного гепатита и склерозирующего холангита в составе перекрёстного синдрома у ребёнка.

In children, autoimmune liver diseases can manifest in a variety of forms, including autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and the co-occurrence of AIH and PSC - the “overlap syndrome.” Early recognition of overlap syndrome is important. Diagnosis of sclerosing cholangitis largely depends on the cholangiographic picture showing single or multiple strictures with dilatation of the biliary tract. The problems of etiology, pathogenesis, diagnosis and treatment of overlap syndrome in children are shown. A clinical example of seronegative autoimmune hepatitis and sclerosing cholangitis as part of a cross syndrome in a child is given.

аутоиммунный гепатитпервичный склерозирующий холангитаутоиммунный склерозирующий холангитперекрёстный синдромдетидиагностикалечениеautoimmune hepatitisprimary sclerosing cholangitisautoimmune sclerosing cholangitiscrossover syndromechildrendiagnosistreatmentReferencesKumar N., Poddar U., Yadav R., Lal H., Pani K., Yachha S. K. et al. Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study. Pediatr Gastroenterol Hepatol Nutr. 2021;24(2):154-163. doi: 10.5223/pghn.2021.24.2.154.Kumar N., Poddar U., Yadav R., Lal H., Pani K., Yachha S. K. et al. Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study. Pediatr Gastroenterol Hepatol Nutr. 2021;24(2):154-163. doi: 10.5223/pghn.2021.24.2.154.Mieli-Vergani G., Vergani D. Paediatric autoimmune liver disease. Arch Dis Child. 2013;98(12):1012-7. doi: 10.1136/archdischild-2013-303848.Mieli-Vergani G., Vergani D. Paediatric autoimmune liver disease. Arch Dis Child. 2013;98(12):1012-7. doi: 10.1136/archdischild-2013-303848.Ricciuto A., Kamath B. M., Hirschfield G. M., Trivedi P. J. Primary sclerosing cholangitis and overlap features of autoimmune hepatitis: A coming of age or an age-ist problem? J Hepatol. 2023;79(2):567-575. doi: 10.1016/j.jhep.2023.02.030.Ricciuto A., Kamath B. M., Hirschfield G. M., Trivedi P. J. Primary sclerosing cholangitis and overlap features of autoimmune hepatitis: A coming of age or an age-ist problem? J Hepatol. 2023;79(2):567-575. doi: 10.1016/j.jhep.2023.02.030.Homberg J.C., Abuaf N., Bernard O., Islam S., Alvarez F., Khalil S. H. et al. Chronic active hepatitis associated with antiliver/kidney microsome antibody type 1: a second type of “autoimmune” hepatitis. Hepatology. 1987;7(6):1333-9. doi: 10.1002/hep.1840070626.Homberg J.C., Abuaf N., Bernard O., Islam S., Alvarez F., Khalil S. H. et al. Chronic active hepatitis associated with antiliver/kidney microsome antibody type 1: a second type of “autoimmune” hepatitis. Hepatology. 1987;7(6):1333-9. doi: 10.1002/hep.1840070626.Kogan J., Safadi R., Ashur Y., Shouval D., Ilan Y. Prognosis of symptomatic versus asymptomatic autoimmune hepatitis: a study of 68 patients. J Clin Gastroenterol. 2002;35:75-81. doi: 10.1097/00004836-200207000-00016.Kogan J., Safadi R., Ashur Y., Shouval D., Ilan Y. Prognosis of symptomatic versus asymptomatic autoimmune hepatitis: a study of 68 patients. J Clin Gastroenterol. 2002;35:75-81. doi: 10.1097/00004836-200207000-00016.Wong G.W., Yeong T., Lawrence D., Yeoman A. D., Verma S., Heneghan M. A. Concurrent extrahepatic autoimmunity in autoimmune hepatitis: implications for diagnosis, clinical course and long-term outcomes. Liver Int. 2017;37(3):449-457. doi: 10.1111/liv.13236.Wong G.W., Yeong T., Lawrence D., Yeoman A. D., Verma S., Heneghan M. A. Concurrent extrahepatic autoimmunity in autoimmune hepatitis: implications for diagnosis, clinical course and long-term outcomes. Liver Int. 2017;37(3):449-457. doi: 10.1111/liv.13236.Gregorio G.V., Portmann B., Karani J. et al. Autoimmune hepatitis/sclerosing cholangitis overlap syndrome in childhood: a 16-year prospective study. Hepatology. 2001;33(3):544-53. doi: 10.1053/jhep.2001.22131.Gregorio G.V., Portmann B., Karani J. et al. Autoimmune hepatitis/sclerosing cholangitis overlap syndrome in childhood: a 16-year prospective study. Hepatology. 2001;33(3):544-53. doi: 10.1053/jhep.2001.22131.Deneau M.R., El-Matary W., Valentino P. L. et al. The natural history of primary sclerosing cholangitis in 781 children: A multicenter, international collaboration. Hepatology. 2017;66(2):518-527. doi: 10.1002/hep.29204.Deneau M.R., El-Matary W., Valentino P. L. et al. The natural history of primary sclerosing cholangitis in 781 children: A multicenter, international collaboration. Hepatology. 2017;66(2):518-527. doi: 10.1002/hep.29204.Boberg K.M., Fausa O., Haaland T., Holter E., Mellbye O. J., Spurkland A., Schrumpf E. Features of autoimmune hepatitis in primary sclerosing cholangitis: an evaluation of 114 primary sclerosing cholangitis patients according to a scoring system for the diagnosis of autoimmune hepatitis. Hepatology. 1996;23(6):1369-76. doi: 10.1002/hep.510230612.Boberg K.M., Fausa O., Haaland T., Holter E., Mellbye O. J., Spurkland A., Schrumpf E. Features of autoimmune hepatitis in primary sclerosing cholangitis: an evaluation of 114 primary sclerosing cholangitis patients according to a scoring system for the diagnosis of autoimmune hepatitis. Hepatology. 1996;23(6):1369-76. doi: 10.1002/hep.510230612.Abdalian R., Dhar P., Jhaveri K., Haider M., Guindi M., Heathcote E. J. Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: evaluating the role of routine magnetic resonance imaging. Hepatology. 2008;47(3):949-57. doi: 10.1002/hep.22073.Abdalian R., Dhar P., Jhaveri K., Haider M., Guindi M., Heathcote E. J. Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: evaluating the role of routine magnetic resonance imaging. Hepatology. 2008;47(3):949-57. doi: 10.1002/hep.22073.Lewin M., Vilgrain V., Ozenne V. et al. Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: a prospective magnetic resonance imaging and histological study. Hepatology. 2009;50(2):528-37. doi: 10.1002/hep.23024.Lewin M., Vilgrain V., Ozenne V. et al. Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: a prospective magnetic resonance imaging and histological study. Hepatology. 2009;50(2):528-37. doi: 10.1002/hep.23024.Trivedi P.J., Hirschfield G. M. Recent advances in clinical practice: epidemiology of autoimmune liver diseases. Gut. 2021;70(10):1989-2003. doi: 10.1136/gutjnl-2020-322362.Trivedi P.J., Hirschfield G. M. Recent advances in clinical practice: epidemiology of autoimmune liver diseases. Gut. 2021;70(10):1989-2003. doi: 10.1136/gutjnl-2020-322362.Deneau M.R., El-Matary W., Valentino P. L. et al. The natural history of primary sclerosing cholangitis in 781 children: A multicenter, international collaboration. Hepatology. 2017;66(2):518-527. doi: 10.1002/hep.29204.Deneau M.R., El-Matary W., Valentino P. L. et al. The natural history of primary sclerosing cholangitis in 781 children: A multicenter, international collaboration. Hepatology. 2017;66(2):518-527. doi: 10.1002/hep.29204.Floreani A., Rizzotto E. R., Ferrara F., Carderi I., Caroli D., Blasone L., Baldo V. Clinical course and outcome of autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome. Am J Gastroenterol. 2005;100(7):1516-22. doi: 10.1111/j.1572-0241.2005.41841.x.Floreani A., Rizzotto E. R., Ferrara F., Carderi I., Caroli D., Blasone L., Baldo V. Clinical course and outcome of autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome. Am J Gastroenterol. 2005;100(7):1516-22. doi: 10.1111/j.1572-0241.2005.41841.x.Weismüller T.J., Trivedi P. J., Bergquist A. et al.; International PSC Study Group. Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis. Gastroenterology. 2017;152(8):1975-1984.e8. doi: 10.1053/j.gastro.2017.02.038.Weismüller T.J., Trivedi P. J., Bergquist A. et al.; International PSC Study Group. Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis. Gastroenterology. 2017;152(8):1975-1984.e8. doi: 10.1053/j.gastro.2017.02.038.Ricciuto A., Hansen B. E., Ngo B., Aloi M. et al. Primary Sclerosing Cholangitis in Children With Inflammatory Bowel Diseases Is Associated With Milder Clinical Activity But More Frequent Subclinical Inflammation and Growth Impairment. Clin Gastroenterol Hepatol. 2020;18(7):1509-1517.e7. doi: 10.1016/j.cgh.2019.08.048.Ricciuto A., Hansen B. E., Ngo B., Aloi M. et al. Primary Sclerosing Cholangitis in Children With Inflammatory Bowel Diseases Is Associated With Milder Clinical Activity But More Frequent Subclinical Inflammation and Growth Impairment. Clin Gastroenterol Hepatol. 2020;18(7):1509-1517.e7. doi: 10.1016/j.cgh.2019.08.048.Bjarnason I., Hayee B., Pavlidis P. et al. Contrasting Pattern of Chronic Inflammatory Bowel Disease in Primary and Autoimmune Sclerosing Cholangitis. EBioMedicine. 2015;2(10):1523-7. doi: 10.1016/j.ebiom.2015.08.041.Bjarnason I., Hayee B., Pavlidis P. et al. Contrasting Pattern of Chronic Inflammatory Bowel Disease in Primary and Autoimmune Sclerosing Cholangitis. EBioMedicine. 2015;2(10):1523-7. doi: 10.1016/j.ebiom.2015.08.041.Maggiore G., Bernard O., Mosca A., Ballot E., Johanet C., Jacquemin E. Long-term outcomes of patients with type 1 or 2 autoimmune hepatitis presenting in childhood. J Hepatol. 2023;78(5):979-988. doi: 10.1016/j.jhep.2023.01.013.Maggiore G., Bernard O., Mosca A., Ballot E., Johanet C., Jacquemin E. Long-term outcomes of patients with type 1 or 2 autoimmune hepatitis presenting in childhood. J Hepatol. 2023;78(5):979-988. doi: 10.1016/j.jhep.2023.01.013.Kammermeier J., Dziubak R., Pescarin M. et al. Phenotypic and Genotypic Characterisation of Inflammatory Bowel Disease Presenting Before the Age of 2 years. J Crohns Colitis. 2017;11(1):60-69. doi: 10.1093/ecco-jcc/jjw118.Kammermeier J., Dziubak R., Pescarin M. et al. Phenotypic and Genotypic Characterisation of Inflammatory Bowel Disease Presenting Before the Age of 2 years. J Crohns Colitis. 2017;11(1):60-69. doi: 10.1093/ecco-jcc/jjw118.Kumar N., Poddar U., Yadav R. et al. Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study. Pediatr Gastroenterol Hepatol Nutr. 2021;24(2):154-163. doi: 10.5223/pghn.2021.24.2.154.Kumar N., Poddar U., Yadav R. et al. Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study. Pediatr Gastroenterol Hepatol Nutr. 2021;24(2):154-163. doi: 10.5223/pghn.2021.24.2.154.Henriksen M., Jahnsen J., Lygren I., Sauar J., Schulz T., Stray N. et al.; Ibsen Study Group. Change of diagnosis during the first five years after onset of inflammatory bowel disease: results of a prospective follow-up study (the IBSEN Study). Scand J Gastroenterol. 2006;41(9):1037-43. doi: 10.1080/00365520600554527.Henriksen M., Jahnsen J., Lygren I., Sauar J., Schulz T., Stray N. et al.; Ibsen Study Group. Change of diagnosis during the first five years after onset of inflammatory bowel disease: results of a prospective follow-up study (the IBSEN Study). Scand J Gastroenterol. 2006;41(9):1037-43. doi: 10.1080/00365520600554527.Bertolini A., Fiorotto R., Strazzabosco M. Bile acids and their receptors: modulators and therapeutic targets in liver inflammation. Semin Immunopathol. 2022;44(4):547-564. doi: 10.1007/s00281-022-00935-7.Bertolini A., Fiorotto R., Strazzabosco M. Bile acids and their receptors: modulators and therapeutic targets in liver inflammation. Semin Immunopathol. 2022;44(4):547-564. doi: 10.1007/s00281-022-00935-7.Campbell C., McKenney P. T., Konstantinovsky D. et al. Bacterial metabolism of bile acids promotes generation of peripheral regulatory T cells. Nature. 2020;581(7809):475-479. doi: 10.1038/s41586-020-2193-0.Campbell C., McKenney P. T., Konstantinovsky D. et al. Bacterial metabolism of bile acids promotes generation of peripheral regulatory T cells. Nature. 2020;581(7809):475-479. doi: 10.1038/s41586-020-2193-0.Hang S., Paik D., Yao L., Kim E., Trinath J., Lu J. et al. Bile acid metabolites control TH17 and Treg cell differentiation. Nature. 2019;576(7785):143-148. doi: 10.1038/s41586-019-1785-z.Hang S., Paik D., Yao L., Kim E., Trinath J., Lu J. et al. Bile acid metabolites control TH17 and Treg cell differentiation. Nature. 2019;576(7785):143-148. doi: 10.1038/s41586-019-1785-z.Paik D., Yao L., Zhang Y., Bae S. et al. Human gut bacteria produce ΤΗ17-modulating bile acid metabolites. Nature. 2022;603(7903):907-912. doi: 10.1038/s41586-022-04480-z.Paik D., Yao L., Zhang Y., Bae S. et al. Human gut bacteria produce ΤΗ17-modulating bile acid metabolites. Nature. 2022;603(7903):907-912. doi: 10.1038/s41586-022-04480-z.Hirschfield G.M., Chazouillères O., Drenth J. P. et al. Effect of NGM282, an FGF19 analogue, in primary sclerosing cholangitis: A multicenter, randomized, double-blind, placebo-controlled phase II trial. J Hepatol. 2019;70(3):483-493. doi: 10.1016/j.jhep.2018.10.035.Hirschfield G.M., Chazouillères O., Drenth J. P. et al. Effect of NGM282, an FGF19 analogue, in primary sclerosing cholangitis: A multicenter, randomized, double-blind, placebo-controlled phase II trial. J Hepatol. 2019;70(3):483-493. doi: 10.1016/j.jhep.2018.10.035.Trauner M., Gulamhusein A., Hameed B. et al. The Nonsteroidal Farnesoid X Receptor Agonist Cilofexor (GS-9674) Improves Markers of Cholestasis and Liver Injury in Patients With Primary Sclerosing Cholangitis. Hepatology. 2019;70(3):788-801. doi: 10.1002/hep.30509.Trauner M., Gulamhusein A., Hameed B. et al. The Nonsteroidal Farnesoid X Receptor Agonist Cilofexor (GS-9674) Improves Markers of Cholestasis and Liver Injury in Patients With Primary Sclerosing Cholangitis. Hepatology. 2019;70(3):788-801. doi: 10.1002/hep.30509.Trivedi P.J., Robinson J., Wright T., Bruns T., Li K., Shah H., et al. Biochemical patterns of prese ntation in primary sclerosing cholangitis: younger age at onset is associated with a lower ALP/AST ratio. Gut 2014;63 (Suppl 1): A93-A94. doi: 10.1136/gutjnl-2014-307263.199.Trivedi P.J., Robinson J., Wright T., Bruns T., Li K., Shah H., et al. Biochemical patterns of prese ntation in primary sclerosing cholangitis: younger age at onset is associated with a lower ALP/AST ratio. Gut 2014;63 (Suppl 1): A93-A94. doi: 10.1136/gutjnl-2014-307263.199.Alvarez F., Berg P. A., Bianchi F. B., Bianchi L. et al.International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31(5):929-38. doi: 10.1016/s0168-8278(99)80297-9.Alvarez F., Berg P. A., Bianchi F. B., Bianchi L. et al.International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31(5):929-38. doi: 10.1016/s0168-8278(99)80297-9.Hennes E.M., Zeniya M., Czaja A. J., Parés A., Dalekos G. N., Krawitt E. L.; International Autoimmune Hepatitis Group. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-76. doi: 10.1002/hep.22322.Hennes E.M., Zeniya M., Czaja A. J., Parés A., Dalekos G. N., Krawitt E. L.; International Autoimmune Hepatitis Group. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-76. doi: 10.1002/hep.22322.Boberg K.M., Chapman R. W., Hirschfield G. M., Lohse A. W., Manns M. P., Schrumpf E.; International Autoimmune Hepatitis Group. Overlap syndromes: the International Autoimmune Hepatitis Group (IAIHG) position statement on a controversial issue. J Hepatol. 2011;54(2):374-85. doi: 10.1016/j.jhep.2010.09.002.Boberg K.M., Chapman R. W., Hirschfield G. M., Lohse A. W., Manns M. P., Schrumpf E.; International Autoimmune Hepatitis Group. Overlap syndromes: the International Autoimmune Hepatitis Group (IAIHG) position statement on a controversial issue. J Hepatol. 2011;54(2):374-85. doi: 10.1016/j.jhep.2010.09.002.Hensel K.O., Kyrana E., Hadzic N. et al. Sclerosing cholangitis in pediatric inflammatory bowel disease: early diagnosis and management affect clinical outcome. J Pediatr. 2021;238:50-56.e3. doi: 10.1016/j.jpeds.2021.07.047.Hensel K.O., Kyrana E., Hadzic N. et al. Sclerosing cholangitis in pediatric inflammatory bowel disease: early diagnosis and management affect clinical outcome. J Pediatr. 2021;238:50-56.e3. doi: 10.1016/j.jpeds.2021.07.047.Zeman M.V., Hirschfield G. M. Autoantibodies and liver disease: uses and abuses. Can J Gastroenterol. 2010;24(4):225-31. doi: 10.1155/2010/431913.Zeman M.V., Hirschfield G. M. Autoantibodies and liver disease: uses and abuses. Can J Gastroenterol. 2010;24(4):225-31. doi: 10.1155/2010/431913.Gouni-Berthold I., Baumeister B., Berthold H. K., Schmidt C. Immunoglobulins and IgG subclasses in patients with inflammatory bowel disease. Hepatogastroenterology. 1999;46(27):1720-3.Gouni-Berthold I., Baumeister B., Berthold H. K., Schmidt C. Immunoglobulins and IgG subclasses in patients with inflammatory bowel disease. Hepatogastroenterology. 1999;46(27):1720-3.Folwaczny C., Noehl N., Endres S. P., Heldwein W., Loeschke K., Fricke H. Antinuclear autoantibodies in patients with inflammatory bowel disease. High prevalence in first-degree relatives. Dig Dis Sci. 1997;42(8):1593-7. doi: 10.1023/a:1018832608899.Folwaczny C., Noehl N., Endres S. P., Heldwein W., Loeschke K., Fricke H. Antinuclear autoantibodies in patients with inflammatory bowel disease. High prevalence in first-degree relatives. Dig Dis Sci. 1997;42(8):1593-7. doi: 10.1023/a:1018832608899.Björnsson H.K., Gudbjornsson B., Björnsson E. S. Infliximab-induced liver injury: clinical phenotypes, autoimmunity and the role of corticosteroid treatment. J Hepatol. 2022;76(1):86-92. doi: 10.1016/j.jhep.2021.08.024.Björnsson H.K., Gudbjornsson B., Björnsson E. S. Infliximab-induced liver injury: clinical phenotypes, autoimmunity and the role of corticosteroid treatment. J Hepatol. 2022;76(1):86-92. doi: 10.1016/j.jhep.2021.08.024.Vaz J.L., Fernandes V., Nogueira F., Arnóbio A., Levy R. A. Infliximab-induced autoantibodies: a multicenter study. Clin Rheumatol. 2016;35(2):325-32. doi: 10.1007/s10067-015-3140-6.Vaz J.L., Fernandes V., Nogueira F., Arnóbio A., Levy R. A. Infliximab-induced autoantibodies: a multicenter study. Clin Rheumatol. 2016;35(2):325-32. doi: 10.1007/s10067-015-3140-6.Gohlke F., Lohse A. W., Dienes H. P. et al. Evidence for an overlap syndrome of autoimmune hepatitis and primary sclerosing cholangitis. J Hepatol. 1996;24(6):699-705. doi: 10.1016/s0168-8278(96)80266-2.Gohlke F., Lohse A. W., Dienes H. P. et al. Evidence for an overlap syndrome of autoimmune hepatitis and primary sclerosing cholangitis. J Hepatol. 1996;24(6):699-705. doi: 10.1016/s0168-8278(96)80266-2.Lüth S., Kanzler S., Frenzel C., Kasper H. U. et al. Characteristics and long-term prognosis of the autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome. J Clin Gastroenterol. 2009;43(1):75-80. doi: 10.1097/MCG.0b013e318157c614.Lüth S., Kanzler S., Frenzel C., Kasper H. U. et al. Characteristics and long-term prognosis of the autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome. J Clin Gastroenterol. 2009;43(1):75-80. doi: 10.1097/MCG.0b013e318157c614.McNair A.N., Moloney M., Portmann B. C., Williams R., McFarlane I. G. Autoimmune hepatitis overlapping with primary sclerosing cholangitis in five cases. Am J Gastroenterol. 1998;93(5):777-84. doi: 10.1111/j.1572-0241.1998.224_a.x.McNair A.N., Moloney M., Portmann B. C., Williams R., McFarlane I. G. Autoimmune hepatitis overlapping with primary sclerosing cholangitis in five cases. Am J Gastroenterol. 1998;93(5):777-84. doi: 10.1111/j.1572-0241.1998.224_a.x.Olsson R., Glaumann H., Almer S. et al. High prevalence of small duct primary sclerosing cholangitis among patients with overlapping autoimmune hepatitis and primary sclerosing cholangitis. Eur J Intern Med. 2009;20(2):190-6. doi: 10.1016/j.ejim.2008.06.004.Olsson R., Glaumann H., Almer S. et al. High prevalence of small duct primary sclerosing cholangitis among patients with overlapping autoimmune hepatitis and primary sclerosing cholangitis. Eur J Intern Med. 2009;20(2):190-6. doi: 10.1016/j.ejim.2008.06.004.Boonstra K., Weersma R. K., van Erpecum K. J. et al.; EpiPSCPBC Study Group. Population-based epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis. Hepatology. 2013;58(6):2045-55. doi: 10.1002/hep.26565.Boonstra K., Weersma R. K., van Erpecum K. J. et al.; EpiPSCPBC Study Group. Population-based epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis. Hepatology. 2013;58(6):2045-55. doi: 10.1002/hep.26565.Creutzfeldt A.M., Piecha F., Schattenberg J. M., Schramm C., Lohse A. W. Long-term outcome in PSC patients receiving azathioprine: Does immunosuppression have a positive effect on survival? J Hepatol. 2020;73(5):1285-1287. doi: 10.1016/j.jhep.2020.07.027.Creutzfeldt A.M., Piecha F., Schattenberg J. M., Schramm C., Lohse A. W. Long-term outcome in PSC patients receiving azathioprine: Does immunosuppression have a positive effect on survival? J Hepatol. 2020;73(5):1285-1287. doi: 10.1016/j.jhep.2020.07.027.

The authors declare that there are no conflicts of interest present.