Related Experiment Video
Updated: Jan 12, 2026
Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach
Published on: May 23, 2025
Reevaluating the clinical course of AMA-positive patients with normal liver enzymes: A large retrospective cohort
Ahmad Yahia1, Fadi Abu Baker2, Mifleh Tatour3
1Gastroenterology Department, Emek Medical Center, Afula 1834111, Israel.
Introduction And Objectives:
The long-term clinical significance of anti-mitochondrial antibody (AMA)-positive patients with normal liver enzymes remains unclear. Despite increasing detection of AMA positivity in asymptomatic individuals, clinicians lack evidence-based protocols for long-term surveillance, and guidelines offer no clear recommendations. This study, the largest of its kind, investigates the natural history, prognostic implications, and risk factors for disease progression in this population.
Materials And Methods:
We conducted a retrospective cohort study using a national healthcare database to identify adults (aged 18 years or older) with a positive AMA and normal alkaline phosphatase (ALP) levels between 2002 and 2023. Demographics, laboratory data, and liver-related outcomes were assessed. Multivariate logistic and Cox regression models were used to evaluate predictors of primary biliary cholangitis (PBC), cirrhosis, and hepatic complications.
Results:
Among 1018 patients (median follow-up 6.3 years (IQR 2.5-11.5), 76 (7.5 %) developed PBC and 30 (2.9 %) progressed to cirrhosis. Liver-related complications were infrequent: esophageal varices (1.1 %), ascites (1.8 %), hepatocellular carcinoma (0.2 %), and liver transplantation (0.1 %). Higher AMA titers were strongly associated with increased risk of PBC, cirrhosis, and complications, showing a clear titer-dependent gradient. Longitudinal analysis also demonstrated titer-associated increases in ALP and bilirubin over time.
Conclusions:
AMA-positive individuals with normal liver enzymes typically experience a benign clinical course. However, high AMA titers identify a subgroup at increased risk for progression to PBC and advanced liver disease. These findings underscore the importance of risk-stratified surveillance strategies in clinical practice, guiding healthcare professionals in the management of their patients.
More Related Videos
Related Concept Videos
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:17Gross Anatomy of the Liver
Located under the diaphragm, the liver is almost entirely ensconced within the rib cage, providing it with substantial protection. Except for the superior most bare area, the liver's surface is...