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6 autoimmune liver disease stories on cholangitis risks, outcomes

Autoimmune liver diseases such as primary biliary cholangitis and primary sclerosing cholangitis lead to inflammation and damage that can be significantly exacerbated by comorbidities such as hepatitis and other chronic liver diseases.

Healio presents the following reports on recent studies that focus on adverse events in endoscopic retrograde cholangiopancreatography, a novel PSC biomarker, and demographics of cholangitis patients.

Adverse events, liver failure common after ERCP in cirrhosis

Adverse events occurred more often among patients with cirrhosis than noncirrhotic cases after endoscopic retrograde cholangiopancreatography and correlated with a higher incidence of acute chronic liver failure, according to a recently published study.

“Recent studies demonstrate that ERCP is safe in patients with cirrhosis, but not surprisingly, those with [Child-Pugh class] B and C have higher adverse-event rates compared with those with [Child-Pugh class] A,” Carles Leal, MD, from the University of Barcelona in Spain, and colleagues wrote. “The study demonstrates that independent risk factors of ERCP adverse events in all patients were the presence of cirrhosis and sphincterotomy and the presence of cirrhosis was an independent risk factor for post-ERCP cholangitis.” Read more

MRI biomarker identifies clinical endpoints in PSC

Researchers identified a potential prognostic biomarker for patients with primary sclerosing cholangitis using magnetic imaging resonance-measured relative enhancement with a hepatocyte-specific contrast agent, according to a recently published study.

“Biomarkers that reflect PSC disease severity in an individual patient are desperately needed for both, daily clinical practice, and as surrogate endpoints and stratification tools in clinical trials,” Jennifer Schulze, from the Hannover Medical School in Germany, and colleagues wrote. “With the advance of hepatocyte-specific contrast agents, namely Gd-EOB-DTPA (gadoxetate disodium), it recently has been discussed that quantitative MRI may have the potential to provide valuable prognostic information in patients with PSC, providing important structural as well as functional information.” Read more

PBC more common in women, Caucasians, older patients in US

The prevalence of primary biliary cholangitis in the United States was highest among women, white patients and patients aged 61 years to 70 years, according to a survey of patients under routine care.

“The Fibrotic Liver Disease (FOLD) Consortium has been developed to address [PBC] knowledge gaps with the primary goal of examining PBC epidemiology, natural history, and treatment within a geographically and racially diverse population of patients under routine clinical care in the United States,” Mei Lu, PhD, from the Henry Ford Health System, and colleagues wrote. Read more

Stents not superior to balloon dilation for dominant strictures in PSC

Short-term stents were not superior to balloon dilatation and correlated with a significantly higher rate of treatment-related severe adverse events among patients with primary sclerosing cholangitis and dominant strictures, according to recently published data.

“Endoscopic treatment of dominant strictures is efficacious in ameliorating symptoms in patients with PSC,” Cyriel Y. Ponsioen, MD, PhD, from the Academic Medical Center in Amsterdam, and colleagues wrote. “Balloon dilatation should be the initial treatment of choice for dominant strictures in PSC. This may be particularly relevant in patients with an intact papilla.” Read more

Autoimmune hepatitis risk low among first-degree relatives

Results from a large Danish-population study showed that first-degree relatives of patients with autoimmune hepatitis had an increased risk for the disease, although the risk was very low.

“Numerous genetic risk factors for [autoimmune hepatitis (AIH)] have been suggested, but genome-wide association studies indicate that genetics plays only a minor role,” Lisbet Grønbæk, MD, from the Aarhus University Hospital in Denmark, and colleagues wrote. “Our study demonstrates that AIH family accumulation is very uncommon, but at the same time indicates that genetic susceptibility does play a role in the complex etiology of AIH.” Read more

Portal hypertension predicts variceal hemorrhage in biliary atresia

Results of a prospective longitudinal analysis showed that the incidence of gastroesophageal variceal hemorrhage in children with biliary atresia was lower than previously described, and that gastroesophageal variceal hemorrhage was more common in patients with features of portal hypertension, according to a presentation at Digestive Disease Week 2018.

“The limitations of previous studies of variceal hemorrhage in biliary atresia include the fact that they were often single center, of retrospective design, and previous mortality rates do not account for improvements in care of patients with biliary atresia with variceal hemorrhage,” Lee Bass, MD, from the Ann & Robert H. Lurie Children’s Hospital of Chicago, said in his presentation. “[Our network] provides the opportunity for further characterization of natural history and risk factors impacting variceal hemorrhage.” Read more