Andrew Mason, M.D. Answers the PBCers
Question 13
a. 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?
b. 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 13
a. 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
b. 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.
Question 14
Are the red blood counts affected by PBC? What are the most important labs for PBC?
Answer 14
The red blood count can be affected by the consequences of portal hypertension if the high venous pressures in the veins coming from the stomach to the liver make blood ooze from any lesions in the stomach.
Most lab tests are important but rising bilirubin levels can be fairly predictive for the need of liver transplantation.
Question 15
Are long term antibiotics bad for PBC?
Answer 15
As long as they are required and not causing undue problems, long term are OK for patients with PBC. In fact, long term non-absorbed antibiotics are used to treat hepatic encephalopathy, if patients become confused from severe liver disease.
Question 16
Is Autoimmune Cholangitis another name for Primary Biliary Cirrhosis or are they two separate conditions? If they are separate conditions, what is the difference between the two concerning symptoms, treatment, prognosis?
Answer 16
AMA negative PBC and autoimmune cholangitis are terms used for the same disease, although arguably patients with autoimmune cholangitis may derive some benefit from immunosuppression. It is likely that they both have the same prognosis.
Question 17
I read somewhere that instead of Calcium Carbonate a PBCer should take Calcium Nitrate tablets. Do you know anything about this?
Answer 17
I am not sure why calcium nitrate would be any better than calcium carbonate. I usually advise patients to take 1.5 grams of calcium per day, such as 3 extra strength Tums.
Question 18
My question: If a person with liver disease related to Hep C and complications preventing a transplant, why can't some of the person's liver be removed, as a liver can regrow in a matter of weeks. Wouldn't this give a person more time?
Answer 18
Cirrhotic livers grow back less easily and are still cirrhotic. Therefore, the operation would be both unnecessary and dangerous.