Specialty Liver Diseases
New York, New York 10029
If you have diseases such as gerd, sojgrens, arthritis etc., that seem to be triggered with the onset of PBC, do they go away or diminish after transplant?
To the extent that certain diseases associated with PBC would respond to the immunosuppression used after a transplant, some symptoms might resolve. For example, if one had rheumatoid arthritis, prednisone used after the transplant might ameliorate some symptoms. Gastroesophageal reflux disease (GERD) is not linked to PBC and would probably not resolve after transplant. I don’t think anyone has looked specifically at Sjogrens syndrome; perhaps we should. I would guess the symptoms would not change since diseases associated with PBC are just that, associated but not caused by PBC, and they tend to run their own courses.
Thomas Shaw-Stiffel, MD
Living Donor Liver Transplantation
Univ. of Pittsburgh
Medical Center – Presbyterian Hospital Center for Liver Diseases
In your experience, what are the most common autoimmune diseases associated with PBC?
The top is thyroid, then come Sjogren’s (dry eyes and mouth), scleroderma (part of systemic sclerosis with bound-down skin in the hands and face, hyerpigmentation and skin lesions called telangiectasias, discrete from the “spiders” seen in cirrhosis), vitiligo (loss of skin pigmentation like Michael Jackson), diabetes mellitus, and adrenal insufficiency….
Melissa Palmer, MD
Specialty: Gastroenterology and Hepatology
Medical advisory board of the ALF New York Chapter
ALF National Chapter Nutrition Education Subcommittee
Have there been any studies done on a connection between pbc and rheumatoid arthritis?
Have there been any studies done on a connection between pbc and rheumatoid arthritis? Since many rheumatologic disorders have an autoimmune origin, it is not surprising that there is a high degree of association between rheumatologicdisorders and PBC. Rhematoid arthritis, which is characterized by joint aches and joint deformities, is often seen in people with PBC. Other rheumatologic disorders occurring in people with PBC include Sjogrens syndrome, which is characterized by dry eyes and dry mouth, scleroderma, characterized by thickening and hardening of the skin and even some internal organs, and raynauds phenomenon, that typically causes the fingertips to turn blue and become numb when exposed to cold weather or emotional stress.
Alfred L. Baker, M.D.
Division of Gastroenterology & Hepatology
Northwestern Memorial Hospital
Some Drs. consider PBC to be a systemic disease and it is not a coincidence that many of us also suffer from other autoimmune diseases/conditions. For e.g. colitis, IBS, arthritis, sojgrens etc. What are your thoughts?
PBC is generally regarded as a multisystem disorder, or a disease that involves several different organs and systems in the body. The liver is most commonly involved, but patients frequently have Sjogrens syndrome (dry mouth and dry eyes due to inflammation of the lacrimal and salivary glands that moisten the eyes and mouth along with a disorder such as rheumatoid arthritis), inflammation of the thyroid gland, and difficulty with swallowing because of involvement of the esophagus. Some patients may have pancreatic involvement, but this usually causes no symptoms. Occasionally patients may have scleroderma, a disease that causes thickening of the skin. However, the irritable bowel syndrome and various forms of colitis are not ordinarily thought to be a part of the multisystem involvement that often characterizes PBC.
David Bernstein, M.D.
Chief, Division of Gastroenterology
North Shore University Hospital
Why do people with GERD suffer from chronic cough? Are there any other problems related to chronic cough and PBC?
GERD can lead to many effects outside of the esophagus and stomach. Gastroesophageal reflux commonly leads to chronic cough and hoarseness. The refluxate or gastric juices pass through the esophagus and enters the trachea and lungs and causes irritation. The irritation leads to coughing. GERD has even been felt to be a possible cause of asthma in some patients. This cough is treated with anti-acid medications.
There are several chronic pulmonary conditions associated with PBC. PBCers can develop interstitial pulmonary fibrosis and those with either Sjogren’s syndrome or scleraderma can also develop a chronic cough.