PBCer
Questions to our Doctors Panel
Marshall Kaplan, M.D.
Chief,
Division of Gastroenterology
December
1999
Question
Among our PBCers we
have greatly varying experiences with the frequency of liver biopsies. What
purpose(s) do they serve, and how often should they be
performed?
Answer
I
do them at baseline and then at one to five year intervals, depending upon how serious the initial biopsy findings were and how well the
subsequent biopsies look. I use biopsies to determine
if the PBC is improving or worsening because the
blood test results do not always parallel what is going on in the liver. I read the biopsies myself and find them very important in
managing patients. They would not be as helpful if I
relied only on the pathologist's interpretation because I can correlate
symptoms, physical findings and blood test results with the biopsy findings.
Andrew Mason, M.D.
Medical
Director of Liver Transplantation Ochsner Clinic
Assistant
Professor of Medicine,
Assistant
Professor of Microbiology, Immunology, and Parasitology,
August
2000
Question
Some
hepatologists do not do or order biopsies now and say that the biopsy is no
longer the "gold standard" for PBC since
blood tests, especially showing elevated AMA's and certain relationships of LFT's, are an equally good indication for diagnosis. What
are your opinions?
Answer
Biopsies
can be done for 2 reasons. They help to make the
diagnosis and also help to stage the disease. As
nearly all our PBC patients are in clinical trials,
we usually perform biopsies to help assess response to treatment
Andrew Mason, M.D.
Medical
Director of Liver Transplantation Ochsner Clinic
Assistant
Professor of Medicine,
Assistant
Professor of Microbiology, Immunology, and Parasitology,
August
2000
Question
An article appeared around 12 years ago saying
that there was a new kind of ultrasound that showed cirrhosis
thereby eliminating the need for biopsy. Is this still
in the works?
Answer
It
is easy to make a diagnosis of cirrhosis if someone has very advanced liver
disease without doing a biopsy by ultrasound and by blood tests. However, for
patients developing early cirrhosis, the liver biopsy remains the gold
standard.
Melissa Palmer M.D.
Specialty:
Gastroenterology and Hepatology
Medical
advisory board of the ALF New York Chapter
ALF
National Chapter Nutrition Education Subcommittee
November
1999
Question
How often should liver
biopsies be done on a patient already diagnosed with PBC?
Answer
There
is no agreed upon, standardized "correct" time for patients with PBC to undergo repeat liver biopsies, (if ever). Patients
on a study protocol often are required to have a biopsy performed at the
beginning and at the end of the study. However, patients not on a study, need
never have a biopsy repeated ( so long as at least one
biopsy was done in order to correctly diagnose and stage the disease).
Nathan M. Bass, MD, PhD
Professor
of Medicine, Medical Director, Liver
Transplantation
Program,
2000-2001
Question
Why is there so much variation in biopsy
experiences among PBCers? Some people say it was a breeze and others have so
much pain. Is it the patient or is it the practitioner?
Answer
Both,
but I believe it is mainly the experience of the
practitioner. Very apprehensive patients often suffer more, but with some
sedation, can have a completely uneventful experience (they may not even
remember it!). The practitioners technique is most
important, and with good technique and experience, a biopsy can be less
disturbing than having a dental filling. However, even the most experienced and
accomplished docs have bad days or encounter an aspect of patient anatomy that
just foils the optimal result. Even with the best approach, some patients do
experience more pain after the procedure than others. Pain experience and
threshold are known to be extremely variable, but even
so, the pain that follows a biopsy should not last more than a day or two.
Nathan M. Bass, MD, PhD
Professor
of Medicine, Medical Director, Liver
Transplantation
Program,
2000-2001
Question
Many people with Hep
C say that they've been given Versed, a sedative.
Others have been given nothing except a local. What or
who determines whether you get anesthesia, sedative, or
nothing]?
Answer
Most
of the time a biopsy can be performed without
sedation. Versed is usually safe, but adds risk to the procedure. Reassurance
and explanation beforehand help a lot to calm nerves, but in the case of a
patient who remains very apprehensive and scared, sedation is appropriate. If
you feel you cannot undergo the procedure without considerable anxiety, discuss
the option of mild sedation with your physician.
Ira M. Jacobson M.D.
Chief,
Division of Gastroenterology & Hepatology
New
York Presbyterian Hospital-Cornell Campus
April
2001
Question
Do you believe liver biopsies give a correct
assessment as to the stage of the disease?
Answer
I believe liver biopsies are quite reliable, though with any
liver disease there is a possibility of "sampling error."
It
remains the "gold standard".
Alfred L. Baker, M.D.
Division of Gastroenterology & Hepatology
Northwestern Memorial Hospital
Chicago, IL
8/8/2003
Question
Is it possible to have normal liver function tests, and yet have a liver biopsy
that shows damage? If there is liver damage wouldn't
this be showing in the labs?
Answer
PBC is occasionally diagnosed
in patients with normal liver chemistry tests, and a biopsy in such individuals
usually shows evidence of the disease. Such individuals often have cellular
infiltrates around the bile ducts, but this is liver damage, albeit mild. Liver
chemistry tests can therefore be normal in patients with a liver biopsy that
shows PBC.
END