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Published on: March 14, 2020
Primary biliary cholangitis with normal alkaline phosphatase: A neglected clinical entity challenging current
Benedetta Terziroli Beretta-Piccoli1, Guido Stirnimann2, Joachim Mertens3
1Epatocentro Ticino, Via Soldino 5, 6900, Lugano, Switzerland.
This study found that primary biliary cholangitis (PBC) can be diagnosed histologically in patients with normal alkaline phosphatase (ALP) levels, even if anti-mitochondrial antibodies (AMA) are negative. Gamma-glutamyl transferase (GGT) may serve as a biomarker for treatment response in these cases.
Area of Science:
- Hepatology
- Immunology
- Gastroenterology
Background:
- Primary biliary cholangitis (PBC) is an autoimmune liver disease diagnosed by specific autoantibodies and elevated alkaline phosphatase (ALP).
- Current diagnostic criteria may not encompass all presentations of PBC, potentially delaying treatment.
Purpose of the Study:
- To investigate liver histology in patients with positive autoantibodies (AMA and/or ANA) but normal ALP levels.
- To evaluate the diagnostic utility of liver biopsy and the role of GGT in PBC patients with normal ALP.
Main Methods:
- Retrospective analysis of the Swiss PBC Cohort Study database.
- Review of liver histology and re-testing of serum autoantibodies (AMA, ANA) in patients with normal ALP.
Main Results:
- Eighty percent of included patients showed histology consistent with PBC.
- Histological diagnosis was achieved in AMA-negative/ANA-positive patients.
- Gamma-glutamyl transferase (GGT) levels significantly decreased after ursodeoxycholic acid treatment (p=0.0018).
Conclusions:
- Liver histology is crucial for diagnosing PBC in patients with normal ALP levels.
- AMA-negative/ANA-positive individuals can have histologically confirmed PBC.
- GGT may be a useful biomarker for monitoring treatment response in PBC patients with normal baseline ALP.
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