Primary biliary cirrhosis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, | If left untreated, patients with primary biliary cirrhosis may progress to develop advanced stage of liver fibrosis and its subsequent complications such as portal hypertension, hepatic encephalopathy. Patients with untreated primary biliary cirrhosis have increased the incidence of hepatocellular carcinoma.<ref name="pmid21529926">{{cite journal| author=Selmi C, Bowlus CL, Gershwin ME, Coppel RL| title=Primary biliary cirrhosis. | journal=Lancet | year= 2011 | volume= 377 | issue= 9777 | pages= 1600-9 | pmid=21529926 | doi=10.1016/S0140-6736(10)61965-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21529926 }} </ref><ref name="pmid9362353">{{cite journal| author=Jones DE, Metcalf JV, Collier JD, Bassendine MF, James OF| title=Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes. | journal=Hepatology | year= 1997 | volume= 26 | issue= 5 | pages= 1138-42 | pmid=9362353 | doi=10.1002/hep.510260508 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9362353 }} </ref><ref name="pmid22504852">{{cite journal| author=Liang Y, Yang Z, Zhong R| title=Primary biliary cirrhosis and cancer risk: a systematic review and meta-analysis. | journal=Hepatology | year= 2012 | volume= 56 | issue= 4 | pages= 1409-17 | pmid=22504852 | doi=10.1002/hep.25788 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22504852 }} </ref> | ||
Prognosis of the disease is generally good with the mild disease and early treatment with [[Ursodeoxycholic acid|Ursodeoxycholic]] acid.<ref name="pmid9934730">{{cite journal| author=Springer J, Cauch-Dudek K, O'Rourke K, Wanless IR, Heathcote EJ| title=Asymptomatic primary biliary cirrhosis: a study of its natural history and prognosis. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 1 | pages= 47-53 | pmid=9934730 | doi=10.1111/j.1572-0241.1999.00770.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9934730 }} </ref><ref name="pmid20800924">{{cite journal| author=Jones DE, Al-Rifai A, Frith J, Patanwala I, Newton JL| title=The independent effects of fatigue and UDCA therapy on mortality in primary biliary cirrhosis: results of a 9 year follow-up. | journal=J Hepatol | year= 2010 | volume= 53 | issue= 5 | pages= 911-7 | pmid=20800924 | doi=10.1016/j.jhep.2010.05.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20800924 }} </ref> | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
Revision as of 04:30, 21 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
If left untreated, patients with primary biliary cirrhosis may progress to develop advanced stage of liver fibrosis and its subsequent complications such as portal hypertension, hepatic encephalopathy. Patients with untreated primary biliary cirrhosis have increased the incidence of hepatocellular carcinoma.[1][2][3] Prognosis of the disease is generally good with the mild disease and early treatment with Ursodeoxycholic acid.[4][5]
Natural History, Complications, and Prognosis
Natural History
- The symptoms of primary biliary cirrhosis usually develop in the fourth and fifth decade of life, and start with symptoms such as fatigue and pruritis .
- If left untreated, patients with primary biliary cirrhosis may progress to develop advance stage of liver fibrosis and its subsequent complications such as portal hypertension, hepatic encepahlopathy. Patients with untreated primary biliary cirrhosis have increased incidence of hepatocellular carcinoma.
Complications
- Common complications of Primary biliary cirrhosis include:[1][2][3]
- Cirrhosis
- Hepatocellular carcinoma
- Metabolic bone disease
- Malabsorption
Prognosis
Prognosis is generally good with the mild disease and early treatment with Ursodeoxycholic acid. Factors associated with poor prognosis include: [6] [4][5][7][2][8][9][10]
- Advanced disease
- Co existing autoimmune disorders such as Sicca syndrome, Thyroiditis, and Scleroderma
- Symptomatic disease
- Increased levels of alkaline phosphatase and bilirubin levels at the time of diagnosis
- Stage III and IV disease on histological examination
- Presence of antinuclear antibodies( antiGp210, antiSp100)
- Cigarette Smoking
- Genetic polymporphism
References
- ↑ 1.0 1.1 Selmi C, Bowlus CL, Gershwin ME, Coppel RL (2011). "Primary biliary cirrhosis". Lancet. 377 (9777): 1600–9. doi:10.1016/S0140-6736(10)61965-4. PMID 21529926.
- ↑ 2.0 2.1 2.2 Jones DE, Metcalf JV, Collier JD, Bassendine MF, James OF (1997). "Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes". Hepatology. 26 (5): 1138–42. doi:10.1002/hep.510260508. PMID 9362353.
- ↑ 3.0 3.1 Liang Y, Yang Z, Zhong R (2012). "Primary biliary cirrhosis and cancer risk: a systematic review and meta-analysis". Hepatology. 56 (4): 1409–17. doi:10.1002/hep.25788. PMID 22504852.
- ↑ 4.0 4.1 Springer J, Cauch-Dudek K, O'Rourke K, Wanless IR, Heathcote EJ (1999). "Asymptomatic primary biliary cirrhosis: a study of its natural history and prognosis". Am J Gastroenterol. 94 (1): 47–53. doi:10.1111/j.1572-0241.1999.00770.x. PMID 9934730.
- ↑ 5.0 5.1 Jones DE, Al-Rifai A, Frith J, Patanwala I, Newton JL (2010). "The independent effects of fatigue and UDCA therapy on mortality in primary biliary cirrhosis: results of a 9 year follow-up". J Hepatol. 53 (5): 911–7. doi:10.1016/j.jhep.2010.05.026. PMID 20800924.
- ↑ Mahl TC, Shockcor W, Boyer JL (1994). "Primary biliary cirrhosis: survival of a large cohort of symptomatic and asymptomatic patients followed for 24 years". J Hepatol. 20 (6): 707–13. PMID 7930469.
- ↑ Lammers WJ, van Buuren HR, Hirschfield GM, Janssen HL, Invernizzi P, Mason AL; et al. (2014). "Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: an international follow-up study". Gastroenterology. 147 (6): 1338–49.e5, quiz e15. doi:10.1053/j.gastro.2014.08.029. PMID 25160979.
- ↑ Nakamura M, Kondo H, Mori T, Komori A, Matsuyama M, Ito M; et al. (2007). "Anti-gp210 and anti-centromere antibodies are different risk factors for the progression of primary biliary cirrhosis". Hepatology. 45 (1): 118–27. doi:10.1002/hep.21472. PMID 17187436.
- ↑ Poupon R, Ping C, Chrétien Y, Corpechot C, Chazouillères O, Simon T; et al. (2008). "Genetic factors of susceptibility and of severity in primary biliary cirrhosis". J Hepatol. 49 (6): 1038–45. doi:10.1016/j.jhep.2008.07.027. PMID 18930330.
- ↑ Corpechot C, Gaouar F, Chrétien Y, Johanet C, Chazouillères O, Poupon R (2012). "Smoking as an independent risk factor of liver fibrosis in primary biliary cirrhosis". J Hepatol. 56 (1): 218–24. doi:10.1016/j.jhep.2011.03.031. PMID 21703179.