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Cirrosis biliar primaria
Elizabeth J Carey1, Ahmad H Ali1, Keith D Lindor2
1Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA.
Lancet (London, England)
|September 15, 2015
Resumen
La cirrosis biliar primaria (CBP) es una enfermedad hepática crónica. Si bien el ácido ursodeoxicólico (UDCA) mejora la supervivencia, se necesitan nuevas terapias para los que no responden, y las hormonas receptoras nucleares son prometedoras.
Área de la Ciencia:
- Hepatología
- Inmunología
- Gastroenterología
Sus antecedentes:
- La cirrosis biliar primaria (CBP) es una enfermedad hepática colestática crónica caracterizada por la destrucción autoinmune de los conductos biliares intrahepáticos pequeños.
- Los anticuerpos antimitocondriales (AMAs, por sus siglas en inglés) son un marcador serológico específico, presente en aproximadamente el 95% de los pacientes con cáncer de próstata.
- La fatiga y el prurito son síntomas comunes, independientemente de la gravedad de la enfermedad.
Objetivo del estudio:
- Revisar la comprensión actual de la epidemiología, la patogénesis y la historia natural de la CBP.
- Discutir las estrategias actuales de manejo y las complicaciones de la CBP.
- Introducir nuevas opciones terapéuticas, incluida la investigación sobre las hormonas de los receptores nucleares.
Principales métodos:
- Revisión de la literatura existente sobre la cirrosis biliar primaria.
- Análisis de los datos de ensayos clínicos para la eficacia del ácido ursodeoxicólico (UDCA).
- Exploración de los resultados de las investigaciones sobre nuevos objetivos terapéuticos.
Principales resultados:
- El ácido ursodeoxicólico (UDCA) ha mejorado la supervivencia sin trasplante en pacientes con cáncer de próstata.
- Aproximadamente el 40% de los pacientes con CBC presentan una respuesta bioquímica inadecuada a la UDCA.
- El trasplante de hígado ofrece excelentes resultados para pacientes con cirrosis descompensada.
Conclusiones:
- A pesar de los beneficios del UDCA, una proporción significativa de pacientes con cáncer de próstata requieren tratamientos alternativos.
- La investigación sobre las hormonas receptoras nucleares presenta vías prometedoras para nuevas terapias de PBC.
- Una comprensión completa de los aspectos multifacéticos de la CBP es crucial para avanzar en la atención al paciente.
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