Earlier recurrence of esophageal varices, following therapy, in patients with primary biliary cirrhosis (PBC) compared with non-PBC patients

Takeshita, Eiji; Matsui, Hidetaka; Shibata, Naozumi; Furukawa, Shinya; Yokota, Tomoyuki; Murakami, Hidehiro; Ikeda, Yoshiou; Hiasa, Yoichi; Matsuura, Bunzo; Michitaka, Kojiro; Onji, Morikazu

doi:10.1007/s00535-004-1447-1

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…However, nonselective beta-blockers are ineffective in preventing the development of varices in unselected patients with cirrhosis [ 174 ]. There is a report showing earlier recurrence of esophageal varices, following endoscopic therapy, in patients with PBC compared with non-PBC patients [ 175 ].…”

Section: Complications Of Pbc and Their Management (Table 2mentioning

confidence: 99%

Primary biliary cirrhosis

Kumagi

Heathcote

2008

Orphanet J Rare Dis

135

124

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Abstract

Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology characterized by injury of the intrahepatic bile ducts that may eventually lead to liver failure. Affected individuals are usually in their fifth to seventh decades of life at time of diagnosis, and 90% are women. Annual incidence is estimated between 0.7 and 49 cases per million-population and prevalence between 6.7 and 940 cases per million-population (depending on age and sex). The majority of patients are asymptomatic at diagnosis, however, some patients present with symptoms of fatigue and/or pruritus. Patients may even present with ascites, hepatic encephalopathy and/or esophageal variceal hemorrhage. PBC is associated with other autoimmune diseases such as Sjogren's syndrome, scleroderma, Raynaud's phenomenon and CREST syndrome and is regarded as an organ specific autoimmune disease. Genetic susceptibility as a predisposing factor for PBC has been suggested. Environmental factors may have potential causative role (infection, chemicals, smoking). Diagnosis is based on a combination of clinical features, abnormal liver biochemical pattern in a cholestatic picture persisting for more than six months and presence of detectable antimitochondrial antibodies (AMA) in serum. All AMA negative patients with cholestatic liver disease should be carefully evaluated with cholangiography and liver biopsy. Ursodeoxycholic acid (UDCA) is the only currently known medication that can slow the disease progression. Patients, particularly those who start UDCA treatment at early-stage disease and who respond in terms of improvement of the liver biochemistry, have a good prognosis. Liver transplantation is usually an option for patients with liver failure and the outcome is 70% survival at 7 years. Recently, animal models have been discovered that may provide a new insight into the pathogenesis of this disease and facilitate appreciation for novel treatment in PBC.

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Section: Complications Of Pbc and Their Management (Table 2mentioning

confidence: 99%

Primary biliary cirrhosis

Kumagi

Heathcote

2008

Orphanet J Rare Dis

135

124

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Abstract

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“…Hemorrhage can be a complication of biliary cirrhosis. For example, PBC patients had an earlier recurrence of esophageal varices compared to non-PBC patients and variceal bleeding complicates PBC, when it is histologically advanced [26, 27]. In our study with laser-induced thrombosis, 54 rats were randomly assigned to 4 groups, two of them underwent common bile duct ligation and in the other two bile duct was identified but not ligated.…”

Section: Resultsmentioning

confidence: 99%

Beneficial Effect of Ultra-Low-Dose Aspirin in Platelet Activity Alterations and Haemorrhage Observed in Experimental Portal Hypertension

et al. 2012

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Ultra-low-dose aspirin has shown a prothrombotic effect in the laser-induced thrombosis model. Several studies of our laboratory have shown a positive effect in rats with two different experimental models of portal hypertension: portal vein ligation, a model with an almost normal liver, and 30 days of bile duct ligation, a model with cirrhosis and presence of ascitis. In both models of portal hypertensive rats, bleeding time was prolonged and thrombi formation, in a laser-induced model of thrombi production, decreased. The hypotheses of the presented studies were that ultra-low-dose aspirin could decrease the bleeding complications in these models and that the mechanism for these effects could act thorough the COX pathway. In different studies, ultra-low dose of aspirin normalized the induced hemorrhage time, thrombi production, and platelet-endothelial cell interaction. The possible beneficial role of these doses of aspirin and mechanism of COX 2 inhibition are discussed.

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“…Since prognosis becomes poor once variceal bleeding occurs 44 and treating esophageal varices is difficult, 50 several groups have attempted to define non‐invasive predictors of esophageal varices in PBC patients 51,52 . Blessler et al.…”

Section: Development Of Esophageal Varicesmentioning

confidence: 99%

“…Since prognosis becomes poor once variceal bleeding occurs 44 and treating esophageal varices is difficult, 50 several groups have attempted to define non-invasive predictors of esophageal varices in PBC patients. 51,52 Blessler et al 51 examined 86 PBC patients and reported that platelet count <200,000/mm 3 , albumin level <4.0 g/dL, and a bilirubin level >20 mmol/L (1.16 mg/ dL) were independent predictors of the development of esophageal varices.…”

Section: Development Of Esophageal Varicesmentioning

confidence: 99%

Natural history of primary biliary cirrhosis

Abe

Onji

2008

Hepatology Research

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The natural history of primary biliary cirrhosis (PBC) has improved significantly over the last two decades. Most patients are diagnosed with asymptomatic PBC (a-PBC). The prognosis of a-PBC is usually better than that of symptomatic PBC (s-PBC). Among a-PBC patients, some remain asymptomatic, whereas others progress to s-PBC. The prognosis of s-PBC is still poor and the main cause of death in PBC is liver failure. Other complications, such as esophageal varices and hepatocellular carcinoma, also affect the prognosis of PBC patients. Ursodeoxycholic acid treatment improves the prognosis of PBC patients in the early stage. There seems to be several types of PBC progression.

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Earlier recurrence of esophageal varices, following therapy, in patients with primary biliary cirrhosis (PBC) compared with non-PBC patients

Abstract: We should be extra careful in the follow-up of patients with PBC after therapy for esophageal varices.

Cited by 4 publications

References 18 publications

Primary biliary cirrhosis

Primary biliary cirrhosis

Beneficial Effect of Ultra-Low-Dose Aspirin in Platelet Activity Alterations and Haemorrhage Observed in Experimental Portal Hypertension

Natural history of primary biliary cirrhosis

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