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©2013 UpToDate ® Print Email Approach to patients with primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC) and features of autoimmune hepatitis (AIH) * Essentially based on the recommendations in the EASL guidelines. • There are no established definitions of the required degree of elevation of serum transaminases or IgG levels. ALT at least 5x, ULN and IgG at least 2x ULN, as previously suggested as criteria for AIH, may serve as guidelines. Δ Immunosuppressive treatment is not evidence-based. It can be suggested that initial treatment is given according to guidelines for AIH. ◊ The AASLD guidelines recommend against UDCA in patients with PSC, whereas the EASL guidelines acknowledge that UDCA is widely used in PSC, although the long-term efficacy remains unproven. Reproduced from: Boberg KM, Chapman RW, Hirschfield GM. Overlap syndromes: the International Autoimmune Hepatitis Group (IAIHG) position statement on a controversial issue. J Hepatol 2011; 54:374. Illustration used with the permission of Elsevier Inc. All rights reserved.