Dr. Ira M. Jacobson

Weill Medical College of Cornell University

Chief,Division of Gastroenterology & Hepatology

New York Presbyterian Hospital-Cornell Campus

Director, Gastrointestinal & Liver Service

New York, NY

Questions & Answers 1 - 5

1. 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".

2. When do you believe we should take the initiative to get on a transplant

list? Should we leave this in our Drs hands? Are symptoms a factor or just the labs and disease stage?

Answer

One should go on a transplant list when there are impending signs of

liver failure, or variceal bleeding, or ascites (fluid in the abdomen), or

intractable itching, or progressive jaundice. Every case is a little

different.

3. What are the chances of reversing the PBC Disease with the use of

Methotrexate and Ursodol? I have been in a Research Study for 5 years,

it is a blind study. So I don't know whether I am getting the

Methotrexate or not. My Doctor says that I am doing wonderful and the

condition, has not progressed, any further. My blood tests are good and

stable. Has there been any studies in the past, that have proven this

drug (Methotrexate) to reverse the disease.

Answer

The use of methotrexate is controversial. To my knowledge, there are

still no published, rigorously done studies that show the drug is effective

in this disease.

4. If total cholesterol is high, but HDLs are higher than LDLs confirmed by a complete lipid profile. Is this normal for PBC? If so, how does this happen? Are the HDLs in PBC the same as normal HDLs, removing the LDLs from circulation and protecting from heart problems? Our cholesterol is very confusing to most of us with PBC.

Answer

Yes, it is "good" cholesterol, and there does not appear to be an excess

of heart disease in pts with PBC.

5. Is it possible to have abnormal LFT's but have normal Bilirubin and progress to end stage of PBC with Bilirubin still showing within the normal range?

Answer

It is rare to need a transplant with PBC and have a normal bilirubin

(unlike some other chronic liver diseases)....

THANK YOU!