Primary biliary cholangitis case-finding: Monocentrical study on patients with incidental finding of anti-mitochondrial antibodies

• Published in: Digestive and liver disease 2023-03, Vol.55, p.S24-S25
• Main Authors: Sciarrone, S.S., Lucchino, B., Adami, A., Ferrighi, E., Fornasa, F., Lombardi, S., Bulighin, G.M., Scattolo, N., Trevisan, M.T.
• Format: Article
• Language: English
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2023.01.045

Anti-mitochondrial antibodies (AMA) are a specific diagnostic marker of Primary Biliary Cholangitis In a lot of situation, in our hospital, thanks to our multidisciplinary group formed by hepatologist and rheumatologist we find some rheumatological patients, with AMA positivity that is sent to Hepatologist for an evaluation, or simply, some patients that casually find in autoimmunity exam this value and laboratory send him to hepatologist. The aims of this observational prospective study were to assess the proportion of AMA positive subjects referred to hepatological evaluation and the evidence of significant liver disease found in these patients. From September 2020 to August 2021, 44 consecutive adult patients without a known history of liver disease were incidentally found positive for immunofluorescent AMA testing, with immunoblotting con-firmed M2 positivity, during diagnostic evaluation mainly for rheumatologic or endocrinologic conditions at San Bonifacio Hospital in Verona, Italy. Referral of these subjects to hepatological evaluation was recorded until February 2022. Evidence of concomitant liver disease was assessed by serum liver enzymes and Fib-4 score (based on age, platelet count, AST, and ALT values) and on sign as fatigue or pruritus. Among patients who were referral to hepatologist 19/44 (43,1%), at the visit admit to suffer of pruritus or fatigue (calculate with fatigue severity scale), all patients permorf elastosonografy, but 100% had low fibrosis value (median value 4,3 Kpa range 3,2-5,7), in 5/44 case we found High value of ALP, that was related with stronger symptomatology. At one year follow up, we found all patients in better condition, the 5 patients with high level of ALP returned in range and of the 19 patients who had symptoms 10 did not suffer anymore, the other 9 maybe suffer for other condition. AMA positive in patients without a history of liver disease evaluated by hepatologist, about 43% show evidence of liver disease, suggestive of PBC. Patients without current evidence of PBC should be monitored and followed up, and begin as soon as possible UDCA. Our results indicate the need for an informational and educational campaign among rheumatologists and endocrinologists on the importance of a hepatological evaluation of patients with incidental AMA positivity.