Fatigue and pruritus at onset identify a more aggressive subset of primary biliary cirrhosis. (23rd April 2014)

• Record Type: Journal Article
• Authors: Quarneti, Chiara; Muratori, Paolo; Lalanne, Claudine; Fabbri, Angela; Menichella, Rita; Granito, Alessandro; Masi, Chiara; Lenzi, Marco; Cassani, Fabio; Pappas, Georgios; Muratori, Luigi
• Is Part Of: Liver international. Volume 35:Number 2(2015:Feb.)
• Page Start: 636
• Page End: 641
• Publication Date: 2014-04-23
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.12560
• Languages: English
• ISSNs: 1478-3223

Abstract

<abstract abstract-type="main" id="liv12560-abs-0001"> <title>Abstract</title> <sec id="liv12560-sec-0001" sec-type="section"> <title>Background & Aims</title> <p>In recent years, primary biliary cirrhosis is mostly diagnosed in patients who are asymptomatic; however, a proportion of cases still present with typical complaints such as fatigue and/or pruritus. We compared biochemical, histological and immunological features of patients with or without fatigue and/or pruritus at onset to see whether the different clinical presentation may eventually impact on disease progression.</p> </sec> <sec id="liv12560-sec-0002" sec-type="section"> <title>Methods</title> <p>We analysed the Bologna cohort of 216 patients with primary biliary cirrhosis referred to our Centre between 1997 and 2007, according to symptomatic (fatigue and/or pruritus) or asymptomatic presentation. Clinical, biochemical, histological and immunological feature at diagnosis, response to ursodeoxycholic acid and progression of the disorder were compared after a mean follow‐up of 81 ± 75 months.</p> </sec> <sec id="liv12560-sec-0003" sec-type="section"> <title>Results</title> <p>At diagnosis, symptomatic patients were significantly more often women (98.6% vs. 87.2%, <italic>P</italic> = 0.004), younger (mean age 49 ± 12 vs. 55 ± 12 years, <italic>P</italic> = 0.003) and with more pronounced biochemical activity, as indicated by higher alkaline phosphatase (mean 2.93 ± 2 vs. 2.12, <italic>P</italic> = 0.002) and aminotransferase (mean 1.92 ± 1 vs. 1.47 ± 1.27, <italic>P</italic> = 0.014) levels, whereas histological stage and autoantibody profile were similar. Symptomatic patients were less likely to respond to ursodeoxycholic acid therapy (63% vs. 81%, <italic>P</italic> = 0.006) and developed more often cirrhosis and its complications (31% vs. 13%, <italic>P</italic> = 0.004).</p> </sec> <sec id="liv12560-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Fatigue and/or pruritus at onset identify a subset of patients with primary biliary cirrhosis who preferentially are women, younger, with a particularly active disease, less responsive to ursodeoxycholic acid treatment, and more inclined to evolve to cirrhosis and its complications.</p> </sec> </abstract>