Identifying patients with undiagnosed primary biliary cholangitis using a clinical management process.

Abstract

Introduction and objectives: Early diagnosis of primary biliary cholangitis (PBC) is fundamental, as treatment with ursodeoxycholic acid (UDCA) prevents its progression. The aim of our study is to investigate undiagnosed patients in our region and to treat retrieved patients.

Patients and methods: Analysis of databases (immunology, biochemistry and other data from their medical records) was performed between January 2019 and December 2021. PBC was diagnosed if anti-mitochondrial antibodies were positive (>1:80) and alkaline phosphatase (AP) was chronically elevated in the absence of other liver disease. Identified patients were contacted.

Results: A total of 306 patients were identified and 221 had previously been diagnosed with PBC and were undergoing treatment. Fifty-one patients did not meet the current criteria for diagnosis and treatment at their last blood test. Six patients had died by the time the study started. Finally, we found 28 patients with a probable diagnosis of PBC who could benefit from treatment (9.6%). We contacted all 28 patients and 16 (57.14%) of them agreed to come to our hospital for diagnosis confirmation, ultrasound and fibroscan. All of them were women, aged between 46 and 74 years (mean 61.18, SD 9.19). Laboratory analysis showed a mean AP of 144.25 (SD 71.03) and mean GGPT of 115.62 (SD 98.42). Mean bilirubin was 0.55 (SD 0.22). Fibroscan showed a mean value of 6.05 kPa. UDCA was initiated in 14 patients; two patients refused treatment.

Conclusions: The use of hospital databases enabled us to diagnose and treat 16 (57.14%) of the 28 detected patients.