Factors Associated With Prevalence and Treatment of Primary Biliary Cholangitis in United States Health Systems

Lü, Mei; Li, Jia; Haller, Irina V.; Romanelli, Robert J.; VanWormer, Jeffrey J.; Rodriguez, Carla V.; Raebel, Marsha A.; Boscarino, Joseph A.; Schmidt, Mark; Daida, Yihe G.; Sahota, Amandeep; Vincent, Jennifer; Bowlus, Christopher L.; Lindor, Keith D.; Rupp, Loralee B; Gordon, Stuart C.; Everline, Rene; Daar, Zahra; Melkonian, Christina; Zhang, Talan; Zhou, Yueren; Wu, Hank; Larkin, Dana; Islam, Nishat; Akkerman, Nonna; Trudeau, Sheri; Kohnhorst, Diane; Shaw, Sally F.; Chiu, Vicki; Donald, Judy; Turner, Michelle; Rubenstein, Kevin; Redd, Jacquelyn L.; Wong, Carmen; Mor, Joanne M.; Bow, Kathy; Pieper, Lisa E.; Anderson, Heather; Tesch, Nathan; Trimble, Solomon; Santos, Mário; Amlin, Tina; Khan, Shamyal; Dunlap, Kevin

doi:10.1016/j.cgh.2017.10.018

Cited by 45 publications

(51 citation statements)

References 19 publications

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“…Not surprisingly, complications of cirrhosis, such as ascites, hepatic encephalopathy and portal hypertension, were independent predictors of higher healthcare use. It is important to note that although previous studies have focused on the cost‐effectiveness of UDCA and the cost of liver transplantation for PBC patients, this study assessed the economic burden on the US Medicare system, which is the major payer for approximately 40% of all PBC patients who are 65 and older …”

Section: Discussionmentioning

confidence: 99%

“…It is important to note that although previous studies have focused on the cost-effectiveness of UDCA and the cost of liver transplantation for PBC patients, (25,(38)(39)(40) this study assessed the economic burden on the US Medicare system, which is the major payer for approximately 40% of all PBC patients who are 65 and older. (18) It has been suggested that patients with a specific condition such as PBC may be more accurately identified from the administrative databases such as Medicare, if we had focused on those with two or more diagnostic codes for PBC. (28) In fact, this approach appears to bias PBC patients with more severe liver disease.…”

Section: Discussionmentioning

confidence: 99%

“…(17) Ursodeoxycholic acid (UDCA) is the first-line treatment for PBC. (18) The use of UDCA slows disease progression and improves outcomes, especially in patients with mild histologic changes and good biochemical response. (18)(19)(20)(21)(22) Nevertheless, there is a group of patients with PBC who do not respond optimally to UDCA.…”

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confidence: 99%

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Primary Biliary Cholangitis in Medicare Population: The Impact on Mortality and Resource Use

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Primary Biliary Cholangitis in Medicare Population: The Impact on Mortality and Resource Use

et al. 2019

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“…(3) One recent paper has shown an overall prevalence of 290 per million, with a prevalence of 430 per million in women and 110 per million in men as opposed to other studies suggesting a 9:1 ratio of women to men. (42) PBC may affect all races and ethnicities, with most data collected from the Caucasian population.…”

Section: Natural Historymentioning

confidence: 99%

Primary Biliary Cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases

et al. 2018

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“…PBC can progress to cirrhosis after many years; however, treatment with the bile acid ursodeoxycholic acid (UDCA) prevents disease progression in those who respond to therapy . Although prevalence estimates vary geographically, a recent US study reports a PBC prevalence of 4.3 per 100,000 in women and 1.1 per 100,000 in men, and similar findings have been reported in Canada . PBC is commonly associated with a number of behavioral symptoms including fatigue, itch, altered mood, and cognitive changes, indicating that PBC can alter brain function .…”

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confidence: 80%

Near‐Infrared Spectroscopy Reveals Brain Hypoxia and Cerebrovascular Dysregulation in Primary Biliary Cholangitis

et al. 2019

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Background and Aims Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease linked to symptoms including fatigue and altered mood/cognition, indicating that chronic liver inflammation associated with PBC can impact brain function. We employed near‐infrared spectroscopy (NIRS), a noninvasive neuroimaging technique, to determine whether patients with PBC exhibit reduced cerebral oxygen saturation (StO2) and altered patterns of microvascular cerebral blood perfusion and whether these alterations were associated with clinical phenotype. This observational case–control study was conducted at a tertiary hospital clinic (University of Calgary Liver Unit). Approach and Results Thirteen female patients with noncirrhotic PBC, seven female patients with cirrhotic PBC, and 11 healthy female controls were recruited by physician referral and word of mouth, respectively. NIRS was used to measure cerebral hemoglobin and oxygen saturation. A wavelet phase coherence method was used to estimate the coherent frequency coupling of temporal changes in cerebral hemodynamics. The PBC group demonstrated significantly reduced cerebral StO2 (P = 0.01, d = 0.84), indicating cerebral hypoxia, significantly increased cerebral deoxygenated hemoglobin concentration (P < 0.01, d = 0.86), and significantly reduced hemodynamic coherence in the low‐frequency band (0.08‐0.15 Hz) for oxygenated hemoglobin concentration (P = 0.02, d = 0.99) and total hemoglobin (tHb) concentration (P = 0.02, d = 0.50), indicating alterations in cerebrovascular activity. Complete biochemical response to ursodeoxycholic acid (UDCA) therapy in early patients with PBC was associated with increased cerebral tHb concentration and decreased hemodynamic coherence. Conclusions Using NIRS, patients with PBC were found to have hypoxia, increased cerebral hemoglobin concentration, and altered cerebrovascular activity, which were reversed in part in UDCA responders. In addition, symptoms and quality‐of‐life measures did not correlate with brain hypoxia or cerebrovascular dysregulation in patients with PBC.

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Factors Associated With Prevalence and Treatment of Primary Biliary Cholangitis in United States Health Systems

Cited by 45 publications

References 19 publications

Primary Biliary Cholangitis in Medicare Population: The Impact on Mortality and Resource Use

Primary Biliary Cholangitis in Medicare Population: The Impact on Mortality and Resource Use

Primary Biliary Cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases

Near‐Infrared Spectroscopy Reveals Brain Hypoxia and Cerebrovascular Dysregulation in Primary Biliary Cholangitis

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