Howard J. Worman, M. D.
Associate Professor of Medicine and Anatomy and Cell Biology
College of Physicians & Surgeons of Columbia University
New York, NY 10032
http://www.columbia.edu/~hjw14/
QUESTIONS & ANSWERS 37 - 42
Question 37
What are your thoughts of a person with PBC taking Tylenol, Advil, Aleve or plain aspirin for arthritis pain.
Answer
Patients with PBC must consult with their doctors regarding the use of any medications, including over-the-counter ones. Anyone using an over-the-counter medicine must also carefully follow the directions on the label and discuss and questions with their doctors and call their doctors if symptoms persist.
Regarding these particular drugs, acetaminophen (Tylenol) is an extraordinarily safe drug when used as directed and is associated with very few side effects.
Ibuprofen (Advil) and naproxen sodium (Aleve) are also very safe when used as directed but can be associated with stomach upset, an increased incidence of gastrointestinal bleeding and in rare cases kidney problems.
Again, I strongly emphasize that patients with persistent arthritis pain should use medications only as directed by their physicians.
Question 38
I've heard of Alpha Lipoic treatments and wondered what your opinion is on the use and safety in PBC. If it is being used, what is the recommend dosage and treatment?
Answer
Alpha lipioc acid is not approved for the treatment of PBC. It is not established to be effective or safe.
Question 39
Has there been any relationship established between macular degeneration and PBC?
Answer
Not to my knowledge.
Question 40
Part 1 Can a person have normal labs, but still Have PBC?
Part 2 Also, is itching common with all liver diseases or just PBC?
Answer (Part 1)
The diagnosis of PBC is based upon a combination of clinical, laboratory and histological (liver biopsy) criteria. Virtually all patients with PBC have an elevated serum alkaline phosphatase activity and more than 90% have detectable antimitochondrial antibodies.
Without either of these two laboratory findings, it would be extremely difficult to say that someone has PBC unless perhaps a liver biopsy was performed for some reason showing the rare diagnostic lesion (in most cases, liver biopsy is usually consistent with PBC and not definitively diagnostic for it).
The blood alkaline phosphatase can become normal in individuals with PBC who take ursodiol.
Answer (Part 2)
Itching can occur in any liver disorder. However, it tends to occur more frequently in so-called cholestatic liver disorders (those in which there is a problem with bile flow), including PBC.
Question 41
Is there a definitive test to prove Gilbert's syndrome? Is it a standard test or does it need to be done in a specific lab?
Answer
The diagnosis of Gilbert syndrome is generally made by excluding other conditions. In Gilbert syndrome, the indirect bilirubin concentration in blood is abnormally elevated. If other causes of this, such as certain inherited disorders or disorders in which red blood cells are abnormally destroyed are excluded, the diagnosis of Gilbert syndrome is made. The diagnosis can also be confirmed if the blood indirect bilirubin concentrations rises with fasting or decreases after taking phenobarbital.
There is no routine definitive diagnostic test for Gilbert syndrome. In some research laboratories, measures of uptake and excretion of certain substances by the liver can be performed to support the diagnosis of Gilbert syndrome; in practice, these are almost never done.
Question 42
Other than URSO what is the treatment to lower indirect bilirubin in a post transplant PBC person?
Answer
There are many causes of elevated bilirubin concentrations. Elevated bilirubin in the blood per se is NOT something that is treated, except in infants in whom very high concentrations of bilirubin can cause problems with the undeveloped nervous system.
If a patient has an elevated serum bilirubin in blood post-transplant or otherwise, a diagnostic work-up must be performed to determine the causes. The underlying cause is treated. URSO (ursodiol) is NOT indicated to "lower the bilirubin" in any condition. It is used in PBC because in several studies it has been shown to slow the progression of the disease, not because it lowers the blood bilirubin concentration.