PBCer
Questions to our Doctors
Panel
Marshall
Kaplan,
M.D.
Chief, Division of Gastroenterology
December 1999
Question
Among our PBCers
we have greatly varying experiences with the frequency of liver biopsies.
What purpose(s) do they serve, and how often should they be performed?
Answer
I do them at baseline and then at one to five year intervals,
depending upon how serious the initial biopsy findings were and how well
the subsequent biopsies look. I use biopsies to determine if the PBC is improving
or worsening because the blood test results do not always parallel what is
going on in the liver. I read the biopsies myself and find them very important
in managing patients. They would not be as helpful if I relied only on the
pathologist's interpretation because I can correlate symptoms, physical findings
and blood test results with the biopsy findings.
Andrew
Mason,
M.D.
Medical Director of Liver Transplantation Ochsner Clinic
Assistant Professor of Medicine,
Assistant Professor of Microbiology, Immunology, and Parasitology,
August 2000
Question
Some hepatologists do not do or order biopsies now and say that
the biopsy is no longer the "gold standard" for PBC since blood tests, especially
showing elevated AMA's and certain relationships of LFT's, are an equally
good indication for diagnosis. What are your opinions?
Answer
Biopsies can be done for 2 reasons. They help to make the diagnosis
and also help to stage the disease. As nearly all our PBC patients are in
clinical trials, we usually perform biopsies to help assess response to treatment
Andrew
Mason,
M.D.
Medical Director of Liver Transplantation Ochsner Clinic
Assistant Professor of Medicine,
Assistant Professor of Microbiology, Immunology, and Parasitology,
August 2000
Question
An article appeared
around 12 years ago saying that there was a new kind of ultrasound that showed
cirrhosis thereby eliminating the need for biopsy. Is this still in the works?
Answer
It is easy to make a diagnosis of cirrhosis if someone has very
advanced liver disease without doing a biopsy by ultrasound and by blood
tests. However, for patients developing early cirrhosis, the liver biopsy
remains the gold standard.
Melissa
Palmer M.D.
Specialty: Gastroenterology and Hepatology
Medical advisory board of the ALF New York Chapter
ALF National Chapter Nutrition Education Subcommittee
November 1999
Question
How often should
liver biopsies be done on a patient already diagnosed with PBC?
Answer
There is no agreed upon, standardized "correct" time for patients
with PBC to undergo repeat liver biopsies, (if ever). Patients on a study
protocol often are required to have a biopsy performed at the beginning and
at the end of the study. However, patients not on a study, need never have
a biopsy repeated ( so long as at least one biopsy
was done in order to correctly diagnose and stage the disease).
Nathan
M. Bass, MD,
PhD
Professor of Medicine, Medical Director, Liver
Transplantation Program,
Show
2000-2001
Question
Why is there so
much variation in biopsy experiences among PBCers? Some people say it was
a breeze and others have so much pain. Is it the patient or is it the
practitioner?
Answer
Both, but I believe it is mainly the experience of the practitioner.
Very apprehensive patients often suffer more, but with some sedation, can
have a completely uneventful experience (they may not even remember it!).
The practitioners technique is most important, and
with good technique and experience, a biopsy can be less disturbing than
having a dental filling. However, even the most experienced and accomplished
docs have bad days or encounter an aspect of patient anatomy that just foils
the optimal result. Even with the best approach, some patients do experience
more pain after the procedure than others. Pain experience and threshold
are known to be extremely variable, but even so, the pain that follows a
biopsy should not last more than a day or two.
Nathan
M. Bass, MD,
PhD
Professor of Medicine, Medical Director, Liver
Transplantation Program,
Show
2000-2001
Question
Many people with
Hep C say that they've been given Versed, a sedative. Others have been given
nothing except a local. What or who determines whether you get anesthesia,
sedative, or nothing]?
Answer
Most of the time a biopsy can be performed without sedation.
Versed is usually safe, but adds risk to the procedure. Reassurance and
explanation beforehand help a lot to calm nerves, but in the case of a patient
who remains very apprehensive and scared, sedation is appropriate. If you
feel you cannot undergo the procedure without considerable anxiety, discuss
the option of mild sedation with your physician.
Ira
M. Jacobson M.D.
Chief, Division of Gastroenterology & Hepatology
New York Presbyterian Hospital-Cornell Campus
Show
April 2001
Question
Do you believe liver
biopsies give a correct assessment as to the stage of the disease?
Answer
I believe liver biopsies are quite reliable, though with any
liver disease there is a possibility of "sampling error."
It remains the "gold standard".
Alfred
L. Baker,
M.D.
Division of Gastroenterology & Hepatology
Northwestern Memorial Hospital
Chicago, IL
8/8/2003
Question
Is it possible to have normal liver function tests, and yet have a liver
biopsy that shows damage? If there is liver damage wouldn't this be showing
in the labs?
Answer
PBC is occasionally diagnosed in patients with normal liver chemistry tests,
and a biopsy in such individuals usually shows evidence of the disease. Such
individuals often have cellular infiltrates around the bile ducts, but this
is liver damage, albeit mild. Liver chemistry tests can therefore be normal
in patients with a liver biopsy that shows PBC.
END