VIDEO: Challenges in diagnosing biliary diseases

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The problem with diagnosis of biliary diseases is that there’s no specific marker or blood test that says these are biliary diseases. However, the serum alkaline phosphatase is usually the best indicator that there may be underlying biliary disease. And the problem is that particularly in primary care facilities, that elevated alkaline phosphatase, if it’s tested at all, it’s often not followed up. That results in a group of patients who really need to be diagnosed who go underdiagnosed. And in the pediatric group, of course, alkaline phosphatase can’t be used because they have growing bones — alkaline phosphatase is in the bones — so they use another enzyme, gamma-glutamyl transpeptidase or GGTP, as sort of a biomarker, if you will, of biliary [diseases] or if I could use the term cholestatic liver diseases as a substitute for biliary diseases.

There’s a huge variety beginning with the genetic disorders in the pediatric group and going up to autoimmune diseases in the adult, particularly with diseases such as primary biliary cholangitis and primary sclerosing cholangitis, which are major adult as well as a drug-induced cholestasis, which is a biliary type of disorder. What is needed really is information, particularly to practicing physicians in the community, about biliary diseases and about the need to follow up on elevated alkaline phosphatase, or GGTP in the pediatric group. GGTP is very nonspecific in the adult group and can be induced by other medications, by alcohol, so that’s not a good serum marker in adults.