Dr. Howard Worman Answers the PBCers 25 - 30

Howard Worman, M.D.

Division of Digestive and Liver Diseases

Departments of Medicine and of Anatomy and Cell Biology

College of Physicians & Surgeons

Columbia University

New York, NY

Question 25

This may be a radical thought, or maybe one already considered and dismissed for good reason: Since many of us have autoimmune diseases other than just PBC, I was wondering if the drugs used to suppress the immune system after transplant (which probably decreases the chance of PBC recurring) could be used as therapy years before transplant in order to control the symptoms of many of our autoimmune diseases.

Answer

Many medical investigators are considering your thought and it is neither "radical" nor has it been "dismissed for good reason." Some of the same drugs used to prevent transplant rejection such as tacrolimus, cyclosporin A and mycophenolate mofetil are being investigated in the treatment of various autoimmune disorders. More studies are necessary at this time.

Question 26

I have read that mercury fillings can cause us a problem. It this true? Could those with liver disease have more problems from oral surgery than those without liver disease?

Answer

While the effects of mercury on liver cells are not completely understood, liver disease from mercury is almost unheard of. I am not aware of any association between mercury filling and liver disease. Individuals with complications of cirrhosis may have more problems from oral surgery because of abnormal blood clotting and possibly an increased risk of infections.

Question 27

Does Methetrexate, Urso or chocline (sp) cause weight gain? Why? Any methods to control it?

Answer

I am not aware of methotrexate, ursodiol or cholchicine causing significant weight gain.

Question 28

I would like to know about Calcium levels and PBC. Looking at our blood work it shows that the calcium has become low, I never read anything about the calcium levels and if there is a certain level before something gets done about it. From what I hear the calcium has nothing to do with the status of a person on the transplant list.

Answer

Many different things can influence blood calcium concentration.

It is controlled by a variety of factors including hormones (parathyroid hormone, calcitonin), kidney excretion, vitamin D, vitamin D modification in the liver and kidney and bone resorption and turnover.

Patients with PBC are often given extra calcium and vitamin D to prevent osteoporosis or bone loss. However, patients with PBC generally do not have low blood calcium concentrations as a result of the disease. If blood calcium becomes lower than normal in any person, including one with PBC, an evaluation of the above factors must be undertaken to establish the cause.

Question 29

Could you explain cognitive brain dysfunction and what is has to do with PBC? Or is this just a term some doctors use for fuzzy brain with PBC when ammonia levels are normal? Thank you.

Answer

Cognition derives from the Latin co- + gnoscere which means to come to know. It is generally used to refer to perception, thinking and learning, higher functions of the human brain. So by "cognitive brain dysfunction" I assume that you mean a problem with the brain in performing these higher functions. PBC per se does not cause problems with cognition. However, with the development of cirrhosis in advanced cases of PBC, hepatic encephalopathy, which is associated with high blood ammonia concentrations, can occur. This can cause problems with cognition. So I guess that "cognitive brain dysfunction" is a term some doctors use to describe a manifestation of hepatic encephalopathy.

Question 30

Do people with PBC have unexplained coughs like choking from their salvia? Could GERD cause a cough? Is GERD common with PBC?

Answer

I am not aware of unexplained coughs or "choking from saliva" being a primary or common symptoms of PBC. Gastroesophageal reflux disease (GERD) certainly can cause chronic cough. People with PBC can get GERD but I am not aware of an increased incidence in such individuals.