Non-alcohol-induced steatohepatitis (NASH) is char-Non-alcohol-induced steatohepatitis (NASH) is inacterized by elevated serum aminotransferase activities completely defined but may result in progressive liver with hepatic steatosis, inflammation, and occasionally disease with cirrhosis. NASH is a disease characterized fibrosis that may progress to cirrhosis. No established by the development of histopathological features comtreatment exists for this potentially serious disorder. parable to those findings induced by excessive alcohol Our aim was to conduct a pilot study to evaluate the intake, without clinical evidence of alcohol abuse. The pathogenesis of NASH is unknown but may rein mean serum levels of alkaline phosphatase, alanine late to excessive accumulation of lipids in the liver. transaminase (ALT), and g-glutamyl transpeptidaseSteatotic livers secondary to alcohol abuse or associ-(GGT) as well as histological grade of steatosis were significant. Among the patients treated with clofibrate, no ated with type II diabetes mellitus contain predomichange from baseline was found in mean ALT, aspartate nantly triglycerides and to a lesser extent cholesterol transaminase (AST), GGT, bilirubin, triglycerides, and esters.9 Elevated hepatic free fatty acids, products of cholesterol, or in histological grade of steatosis, inflam-triglyceride hydrolysis, have been identified in fatty mation, or fibrosis after 12 months of treatment as com-liver of pregnancy, 10 alcohol-induced hepatitis, 11 and pared with entry. Alkaline phosphatase activities de-morbid obesity 11,12 and have been shown to cause cellucreased significantly from baseline. Despite the known lar injury. PATIENTS AND METHODSFrom the Mayo Clinic and Foundation, Rochester, MN.

Background Primary sclerosing cholangitis results in elevated but fluctuating serum alkaline phosphatase levels that occasionally return to normal. Aims To investigate the frequency of normalization of alkaline phosphatase in newly diagnosed primary sclerosing cholangitis patients and the subsequent clinical outcomes. Methods Records of newly diagnosed primary sclerosing cholangitis patients were examined retrospectively for laboratory values and clinical end points (cholangiocarcinoma, liver transplantation and death) within 10 years of diagnosis. Data from a recent prospective ursodeoxycholic acid treatment trial were also studied. Results Eighty-seven patients met the inclusion criteria. Normalization of alkaline phosphatase was seen in 35 (40%) patients. Five (14%) patients with normalization reached an end point whereas 17 (33%) of the patients with persistent elevation reached an end point (P=0.02). Ursodeoxycholic acid was used similarly by both groups. When the investigative criteria were applied to a prospective trial, there was again a significant relationship between normalization of alkaline phosphatase and survival in patients receiving ursodeoxycholic acid (P<0.01) and the placebo group (P=0.02). Conclusions Serum alkaline phosphatase was found to normalize in a high proportion of newly diagnosed primary sclerosing cholangitis patients. This was significantly associated with a better prognosis in a retrospective cohort and when data from a prospective treatment trial was evaluated.

Complications requiring hospitalizations occur in over 10% of PSC patients undergoing ERCP. Cholangitis occurs more often in PSC patients and correlates with the length of the procedure. Further studies to confirm the role of aggressive prophylactic antibiotics in patients with PSC who undergo prolonged procedures are warranted.

PREsTo accurately predicts hepatic decompensation in PSC and exceeds the performance among other widely available, noninvasive prognostic scoring systems. This article is protected by copyright. All rights reserved.