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Updated: Feb 2, 2026

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
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Alkaline Phosphatase Normalization Occurs Less Frequently in Hispanic Patients With Primary Biliary Cholangitis.

Paul Yoon1, Adriana Shen1, Matthew Chen1

  • 1Department of Medicine, Keck School of Medicine of USC, Los Angeles, California.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|January 31, 2026
PubMed
Summary

Hispanic and non-White patients with primary biliary cholangitis (PBC) are less likely to achieve alkaline phosphatase (ALP) normalization with ursodeoxycholic acid (UDCA) treatment. Addressing disparities in treatment response for these underserved populations is crucial for optimal outcomes.

Keywords:
Alkaline PhosphataseAutoimmune Liver DiseaseBiochemical RemissionCholestatic Liver DiseaseUrsodeoxycholic Acid

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Area of Science:

  • Hepatology
  • Clinical Research
  • Biochemistry

Background:

  • Alkaline phosphatase (ALP) normalization is a key treatment goal for primary biliary cholangitis (PBC).
  • Racial and ethnic disparities in treatment response to ursodeoxycholic acid (UDCA) are not well understood, particularly in Hispanic populations.

Purpose of the Study:

  • To evaluate racial and ethnic differences in achieving complete biochemical remission (CBR) with UDCA in PBC patients.
  • To specifically examine treatment outcomes in Hispanic populations within the East Los Angeles Latinx PBC (ELLA-PBC) cohort.

Main Methods:

  • Retrospective analysis of the ELLA-PBC cohort (2006-2022) using AASLD criteria for PBC diagnosis.
  • Kaplan-Meier methods for transplant-free survival (TFS) and decompensation events (DE).
  • Multivariable logistic regression to assess factors associated with 1-year CBR (ALP ≤1 × ULN) after UDCA initiation.

Main Results:

  • Hispanic and non-White patients (77.5%) were compared to non-Hispanic White (NHW) patients (22.5%).
  • No significant differences in 5-year TFS or DE were observed across racial/ethnic groups.
  • At 1-year, CBR rates were significantly lower in Hispanic (13.8%) and non-White (13.2%) patients compared to NHW patients (41.4%), with adjusted odds ratios of 0.31 and 0.23, respectively.

Conclusions:

  • Hispanic and non-White patients with PBC demonstrate significantly lower rates of achieving CBR (ALP normalization) compared to NHW patients.
  • These disparities persist despite comparable baseline ALP levels.
  • Identifying and addressing barriers to UDCA treatment response in underserved populations is essential for achieving optimal therapeutic targets in PBC.