Portal Hypertension and Primary Biliary Cirrhosis: Effect of Long-Term Ursodeoxycholic Acid Treatment
Background & Aims
Portal hypertension can complicate primary biliary cirrhosis, but studies evaluating the direct measurement of the portohepatic gradient (PHG) are rare. The aim of the study was to determine the prevalence and prognostic value of portal hypertension in patients treated with ursodeoxycholic acid.
Methods
A total of 132 patients from a local “PBC clinic” were enrolled in this cohort study. The PHG and biochemical values were measured at inclusion and every 2 years. Factors associated with survival were analyzed.
Results
Mean PHG at inclusion was 7.2 ± 5.8 mm Hg. It was higher than normal (6 mm Hg) in 46 patients (34.9%) and higher than 12 mm Hg (variceal bleeding risk limit) in 26 patients (19.7%). There was a difference between the 3 subgroups in the probability of survival free of liver transplantation (P < .0003). After 2 years of treatment, a decreased or stable PHG (hazard ratio, 4.64; 95% confidence interval, 2.01–10.72) and normalization of aspartate aminotransferase (AST) level (hazard ratio, 2.89; 95% confidence interval, 1.03–8.05) were predictive of better survival on multivariate analysis. “Responders” (stable or improved PHG and normalized AST level at 2 years) have a 15-year survival similar to that of a control Quebec female population.
Conclusions
Significant portal hypertension is a common complication of primary biliary cirrhosis. Changes in the PHG and normalized AST level after 2 years of ursodeoxycholic acid treatment can be used to identify a subgroup of responders with survival comparable to that of a control population.
Abbreviations used in this paper: AP, alkaline phosphatase, GGT, γ-glutamyl transpeptidase, PBC, primary biliary cirrhosis, PHG, portohepatic gradient
S.M's current affiliation is: Chiba College of Health Science, Chiba, Japan.
The authors disclose the following: Supported in part by a university/industry grant from the National Research Council of Canada and Interfalk Canada (1988–1991) and by an unrestricted grant from Jouveinal Canada (1991–1995).
None of the authors have any conflict of interest to disclose with companies making the concerned or a competing product. The authors were collectively responsible for the study design, data collection, statistical analysis, and interpretation of data; the writing of the manuscript; and the decision to submit the manuscript for publication. There was no writing assistance.
PII: S0016-5085(08)01329-2
doi:10.1053/j.gastro.2008.07.019
© 2008 AGA Institute. Published by Elsevier Inc. All rights reserved.
Refers to article:
- Continuing Medical Education Exam 2: November 2008 , 10 October 2008
- Portal Hypertension in Primary Biliary Cirrhosis: A Potentially Reversible Harbinger of Demise , 09 October 2008
