Reviewer's report 
 Autoimmune hepatitis in India: is it uncommon or underdiagnosed Title: 
 2  8 February 2005 Version: Date: 
 Shiv K Sarin Reviewer: 
Reviewer's report: 
Comments 
Autoimmune Hepatitis in India 
The study by Choudhary et al is related to Autoimmune Hepatitis In India. 
They have suggested that this disease is rather uncommon and presents late 
in the Indian context. There are several major concerns with this study: 
Comments: 
1. It is not clear, which components of the criteria of the 
International Autoimmune Hepatitis Group were present in the 30 patients 
with definite AIH and 8 patients with probable AIH. These have not been 
specified at all. 
2. Only one patient was positive for AMA, however PBC was 
diagnosed in three patients. How? 
3. In patients with chronic presentation and not undergoing 
liver biopsy, how was the presence of cirrhosis excluded? 
4. In three patients without antibody positivity, what 
diagnostic criteria were fulfilled. What were their liver histology 
findings and were they definite AIH or probable AIH based on the 
international criteria. 
5. No mention has been made of the dilutions of ANA, ASMA, 
etc. in the results. 
6. The results are very casually written. The treatment 
options regimens, the inclusion and exclusion criteria, end-point of therapy 
and treatment response have not been defined. 
7. Discussion is quite speculative and is a repetition of 
results. It is mentioned in the first Para that there is low prevalence of 
AIH due to genetic or geographic reasons. No basis has been given. 
8. Overall, there is nothing new in this study. There are 
already published recent and large Indian studies and authors have not found 
much difference in their study as compared to previous Indian studies. 
Reviewer's report 
 Autoimmune hepatitis in India: is it uncommon or underdiagnosed Title: 
 2  8 February 2005 Version: Date: 
 Shiv K Sarin Reviewer: 
Reviewer's report: 
Comments 
Autoimmune Hepatitis in India 
The study by Choudhary et al is related to Autoimmune Hepatitis In India. 
They have suggested that this disease is rather uncommon and presents late 
in the Indian context. There are several major concerns with this study: 
Comments: 
1. It is not clear, which components of the criteria of the 
International Autoimmune Hepatitis Group were present in the 30 patients 
with definite AIH and 8 patients with probable AIH. These have not been 
specified at all. 
2. Only one patient was positive for AMA, however PBC was 
diagnosed in three patients. How? 
3. In patients with chronic presentation and not undergoing 
liver biopsy, how was the presence of cirrhosis excluded? 
4. In three patients without antibody positivity, what 
diagnostic criteria were fulfilled. What were their liver histology 
findings and were they definite AIH or probable AIH based on the 
international criteria. 
5. No mention has been made of the dilutions of ANA, ASMA, 
etc. in the results. 
6. The results are very casually written. The treatment 
options regimens, the inclusion and exclusion criteria, end-point of therapy 
and treatment response have not been defined. 
7. Discussion is quite speculative and is a repetition of 
results. It is mentioned in the first Para that there is low prevalence of 
AIH due to genetic or geographic reasons. No basis has been given. 
8. Overall, there is nothing new in this study. There are 
already published recent and large Indian studies and authors have not found 
much difference in their study as compared to previous Indian studies. 
Please review this paper.
user
Reviewer's report 
 Autoimmune hepatitis in India: is it uncommon or underdiagnosed Title: 
 2  8 February 2005 Version: Date: 
 Shiv K Sarin Reviewer: 
Reviewer's report: 
Comments 
Autoimmune Hepatitis in India 
The study by Choudhary et al is related to Autoimmune Hepatitis In India. 
They have suggested that this disease is rather uncommon and presents late 
in the Indian context. There are several major concerns with this study: 
Comments: 
1. It is not clear, which components of the criteria of the 
International Autoimmune Hepatitis Group were present in the 30 patients 
with definite AIH and 8 patients with probable AIH. These have not been 
specified at all. 
2. Only one patient was positive for AMA, however PBC was 
diagnosed in three patients. How? 
3. In patients with chronic presentation and not undergoing 
liver biopsy, how was the presence of cirrhosis excluded? 
4. In three patients without antibody positivity, what 
diagnostic criteria were fulfilled. What were their liver histology 
findings and were they definite AIH or probable AIH based on the 
international criteria. 
5. No mention has been made of the dilutions of ANA, ASMA, 
etc. in the results. 
6. The results are very casually written. The treatment 
options regimens, the inclusion and exclusion criteria, end-point of therapy 
and treatment response have not been defined. 
7. Discussion is quite speculative and is a repetition of 
results. It is mentioned in the first Para that there is low prevalence of 
AIH due to genetic or geographic reasons. No basis has been given. 
8. Overall, there is nothing new in this study. There are 
already published recent and large Indian studies and authors have not found 
much difference in their study as compared to previous Indian studies. 
assistant