Duke Gastrointestinal/Liver Pathology faculty members Wei Chen, MD, (first author) and Fengming Chen, MD, PhD (corresponding author) published a paper titled "When to Consider AIH–PBC Overlap Syndrome in the Pathology Report" in the July 2026 issue of the American Journal of Surgical Pathology (AJSP).
Autoimmune hepatitis–primary biliary cholangitis (AIH–PBC) overlap syndrome remains a diagnostic challenge because there are no universally accepted diagnostic criteria. Current frameworks, including the Paris Criteria, have important limitations that may lead to both overdiagnosis and under recognition of the condition. Because patients with AIH–PBC overlap syndrome may require different management strategies than those with either autoimmune hepatitis or primary biliary cholangitis alone, accurate and timely diagnosis is essential.
To address this challenge, the authors developed a practical, pathology-centered algorithm that begins with histologic findings and then incorporates liver enzyme results, serologic data, and other key clinical information. Unlike existing diagnostic frameworks that treat pathology as only one component of a broader set of diagnostic criteria, this approach places tissue findings at the center of the diagnostic process and provides pathologists with a straightforward way to determine when overlap syndrome should be considered and reported.
By improving diagnostic accuracy, reporting consistency, and communication between pathologists and treating clinicians, this simple, easy-to-follow approach guides pathologists on when to raise and report the possibility of overlap syndrome ensuring that patients receive the most appropriate evaluation and treatment. The authors hope the framework will serve as an accessible tool for practicing pathologists and foster more coordinated care for patients with complex autoimmune liver diseases.
AncillaryA studies supporting this work were funded by a Clinical Faculty Research Pilot Award from the Duke University Department of Pathology.
Fengming Chen, MD, PhD, joined Duke Pathology in 2022. She graduated from Tongji Medical College of Huazhong University of Science and Technology in China, with additional training in internal medicine and clinical gastroenterology. Her academic interests include clinical and translational research related to the gastrointestinal system, liver, and pancreas.
Wei Chen, MD, joined the department in 2021 and was named director of Duke’s Surgical Pathology Gastrointestinal (GI) Fellowship Program in 2025. She earned her MD at Zhejiang University School of Medicine in China and completed Anatomic Pathology/Clinical Pathology (AP/CP) residency training at Case Western Reserve University Hospitals in Cleveland, followed by a surgical pathology fellowship at Brigham and Women’s Hospital in Boston. She then completed a subspecialty fellowship in gastrointestinal pathology at the University of Pittsburgh.