The effect of ursodeoxycholic acid on the florid duct lesion of primary biliary cirrhosis (2023)

The frequency with which florid duct lesions are seen in needle-biopsy specimens of the liver was assessed in patients with primary biliary cirrhosis (PBC) enrolled in a 2-year randomized, double-blind, placebo- controlled trial of ursodeoxycholic acid (UDCA) versus placebo. Paired biopsy specimens obtained at entry and after 2 years on medication were reviewed blindly and mostly simultaneously by a panel of 5 hepatopathologists who, earlier, had characterized the florid duct lesion, which has been well described in the pathology literature. Florid duct lesions at entry were identified in approximately 36%. Patients with earlier disease showed florid duct lesions much more frequently than those with more advanced disease. The prevalence of florid duct lesions in 60 patients receiving placebo medication fell from 38.3% to 21.7%, P = .025, over the period of 2 years. The prevalence of florid duct lesions also decreased in the 55 patients receiving UDCA, from 32.7% to 18.2%, P = .046. The prevalences of these lesions in the placebo and UDCA patients at entry and at 2 years were not significantly different from each other. The findings suggest that UDCA does not prevent ongoing bile duct destruction in patients with PBC. Instead, they support the impression that UDCA exerts its beneficial effects by protecting against the consequences of bile duct destruction.

Original languageEnglish (US)
Pages (from-to)602-605
Number of pages4
JournalHepatology
Volume30
Issue number3
DOIs
StatePublished - 1999
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Combes, B., Markin, R. S., Wheeler, D. E., Rubin, R., West, A. B., Mills, A. S., Eigenbrodt, E. H., Maddrey, W. C., Munoz, S. J., Garcia-Tsao, G., Bonner, G. E., Boyer, J. L., Luketic, V. A., Shiffman, M. L., Peters, M. G., White, H. M., Zetterman, R. K., & Carithers, R. L. (1999). The effect of ursodeoxycholic acid on the florid duct lesion of primary biliary cirrhosis. Hepatology, 30(3), 602-605. https://doi.org/10.1002/hep.510300315

(Video) Primary Sclerosing Cholangitis: Visual Explanation for Students

Combes, B, Markin, RS, Wheeler, DE, Rubin, R, West, AB, Mills, AS, Eigenbrodt, EH, Maddrey, WC, Munoz, SJ, Garcia-Tsao, G, Bonner, GE, Boyer, JL, Luketic, VA, Shiffman, ML, Peters, MG, White, HM, Zetterman, RK & Carithers, RL 1999, 'The effect of ursodeoxycholic acid on the florid duct lesion of primary biliary cirrhosis', Hepatology, vol. 30, no. 3, pp. 602-605. https://doi.org/10.1002/hep.510300315

Combes B, Markin RS, Wheeler DE, Rubin R, West AB, Mills AS et al. The effect of ursodeoxycholic acid on the florid duct lesion of primary biliary cirrhosis. Hepatology. 1999;30(3):602-605. https://doi.org/10.1002/hep.510300315

Combes, Burton ; Markin, Rodney S. ; Wheeler, Donald E. et al. / The effect of ursodeoxycholic acid on the florid duct lesion of primary biliary cirrhosis. In: Hepatology. 1999 ; Vol. 30, No. 3. pp. 602-605.

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(Video) Primary Biliary Cholangitis

title = "The effect of ursodeoxycholic acid on the florid duct lesion of primary biliary cirrhosis",

abstract = "The frequency with which florid duct lesions are seen in needle-biopsy specimens of the liver was assessed in patients with primary biliary cirrhosis (PBC) enrolled in a 2-year randomized, double-blind, placebo- controlled trial of ursodeoxycholic acid (UDCA) versus placebo. Paired biopsy specimens obtained at entry and after 2 years on medication were reviewed blindly and mostly simultaneously by a panel of 5 hepatopathologists who, earlier, had characterized the florid duct lesion, which has been well described in the pathology literature. Florid duct lesions at entry were identified in approximately 36%. Patients with earlier disease showed florid duct lesions much more frequently than those with more advanced disease. The prevalence of florid duct lesions in 60 patients receiving placebo medication fell from 38.3% to 21.7%, P = .025, over the period of 2 years. The prevalence of florid duct lesions also decreased in the 55 patients receiving UDCA, from 32.7% to 18.2%, P = .046. The prevalences of these lesions in the placebo and UDCA patients at entry and at 2 years were not significantly different from each other. The findings suggest that UDCA does not prevent ongoing bile duct destruction in patients with PBC. Instead, they support the impression that UDCA exerts its beneficial effects by protecting against the consequences of bile duct destruction.",

author = "Burton Combes and Markin, {Rodney S.} and Wheeler, {Donald E.} and Raphael Rubin and West, {A. Brian} and Mills, {A. Scott} and Eigenbrodt, {Edwin H.} and Maddrey, {Willis C.} and Munoz, {Santiago J.} and Guadalupe Garcia-Tsao and Bonner, {Gregory E.} and Boyer, {James L.} and Luketic, {Velimir A.} and Shiffman, {Mitchell L.} and Peters, {Marion G.} and White, {Heather M.} and Zetterman, {Rowen K.} and Carithers, {Robert L.}",

year = "1999",

doi = "10.1002/hep.510300315",

language = "English (US)",

volume = "30",

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T1 - The effect of ursodeoxycholic acid on the florid duct lesion of primary biliary cirrhosis

(Video) Primary Biliary Cholangitis

AU - Combes, Burton

AU - Markin, Rodney S.

AU - Wheeler, Donald E.

AU - Rubin, Raphael

AU - West, A. Brian

AU - Mills, A. Scott

AU - Eigenbrodt, Edwin H.

AU - Maddrey, Willis C.

AU - Munoz, Santiago J.

AU - Garcia-Tsao, Guadalupe

AU - Bonner, Gregory E.

AU - Boyer, James L.

AU - Luketic, Velimir A.

AU - Shiffman, Mitchell L.

AU - Peters, Marion G.

AU - White, Heather M.

AU - Zetterman, Rowen K.

(Video) Primary Biliary Cholangitis - An interview with John Vierling (part 1)

AU - Carithers, Robert L.

PY - 1999

Y1 - 1999

N2 - The frequency with which florid duct lesions are seen in needle-biopsy specimens of the liver was assessed in patients with primary biliary cirrhosis (PBC) enrolled in a 2-year randomized, double-blind, placebo- controlled trial of ursodeoxycholic acid (UDCA) versus placebo. Paired biopsy specimens obtained at entry and after 2 years on medication were reviewed blindly and mostly simultaneously by a panel of 5 hepatopathologists who, earlier, had characterized the florid duct lesion, which has been well described in the pathology literature. Florid duct lesions at entry were identified in approximately 36%. Patients with earlier disease showed florid duct lesions much more frequently than those with more advanced disease. The prevalence of florid duct lesions in 60 patients receiving placebo medication fell from 38.3% to 21.7%, P = .025, over the period of 2 years. The prevalence of florid duct lesions also decreased in the 55 patients receiving UDCA, from 32.7% to 18.2%, P = .046. The prevalences of these lesions in the placebo and UDCA patients at entry and at 2 years were not significantly different from each other. The findings suggest that UDCA does not prevent ongoing bile duct destruction in patients with PBC. Instead, they support the impression that UDCA exerts its beneficial effects by protecting against the consequences of bile duct destruction.

AB - The frequency with which florid duct lesions are seen in needle-biopsy specimens of the liver was assessed in patients with primary biliary cirrhosis (PBC) enrolled in a 2-year randomized, double-blind, placebo- controlled trial of ursodeoxycholic acid (UDCA) versus placebo. Paired biopsy specimens obtained at entry and after 2 years on medication were reviewed blindly and mostly simultaneously by a panel of 5 hepatopathologists who, earlier, had characterized the florid duct lesion, which has been well described in the pathology literature. Florid duct lesions at entry were identified in approximately 36%. Patients with earlier disease showed florid duct lesions much more frequently than those with more advanced disease. The prevalence of florid duct lesions in 60 patients receiving placebo medication fell from 38.3% to 21.7%, P = .025, over the period of 2 years. The prevalence of florid duct lesions also decreased in the 55 patients receiving UDCA, from 32.7% to 18.2%, P = .046. The prevalences of these lesions in the placebo and UDCA patients at entry and at 2 years were not significantly different from each other. The findings suggest that UDCA does not prevent ongoing bile duct destruction in patients with PBC. Instead, they support the impression that UDCA exerts its beneficial effects by protecting against the consequences of bile duct destruction.

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(Video) Updates in the Management of Primary Biliary Cholangitis and Primary Sclerosing Cholangitis

SN - 0270-9139

IS - 3

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FAQs

How does ursodeoxycholic acid work for PBC? ›

Ursodeoxycholic acid (UDCA).

It helps move bile through your liver. UDCA doesn't cure primary biliary cholangitis, but it seems to improve liver function and reduce liver scarring. It's less likely to help with itching and fatigue. Side effects may include weight gain, hair loss and diarrhea.

What is florid duct lesion? ›

The florid duct lesion, defined as a granulomatous destruction of the bile ducts, is the histological hallmark of PBC. The granulomatous inflammation may be either well-formed or vague, and is accompanied by lymphocytes and variable numbers of plasma cells, all of which are centered on the bile duct [6].

What is florid cirrhosis? ›

Florid cirrhosis can be distinguished grossly from the ordinary fatty liver with or without hepatic failure by (1) polymorphism of structure on the cut surfaces, especially the focal reversal of the lobular architecture and (2) great decrease in yellow color and doughy consistency.

How long should ursodeoxycholic acid be taken? ›

For the first 3 months of treatment, Ursodeoxycholic acid should be taken divided over the day. The capsules should be swallowed whole with water. Care should be taken to ensure that they are taken regularly. The use of Ursodeoxycholic acid capsules in PBC may be continued indefinitely.

Is ursodeoxycholic acid an effective treatment for primary biliary cirrhosis? ›

Ursodeoxycholic acid (UDCA) is the main treatment for PBC. It can help prevent or delay liver damage in most people, particularly if you start taking it in the early stages of the condition. But it does not improve symptoms such as itchy skin or fatigue.

What is ursodeoxycholic acid mechanism of action? ›

Multiple mechanisms of action of UDCA have been described aiming at one or more of the pathogenetic processes of cholestatic liver diseases: (1) protection of injured cholangiocytes against toxic effects of bile acids, (2) stimulation of impaired biliary secretion, (3) stimulation of detoxification of hydrophobic bile ...

How is primary sclerosing cholangitis treated? ›

A liver transplant is the only treatment known to cure primary sclerosing cholangitis. During a liver transplant, surgeons remove your diseased liver and replace it with a healthy liver from a donor.

What is Ductular reaction? ›

Ductular reaction refers to an increased number of ductules (the finest ramifications of the biliary tree), accompanied by polymorphonuclear leukocytes and an increase in matrix, leading to periportal fibrosis and eventually biliary cirrhosis.

What is primary sclerosing cholangitis? ›

Primary sclerosing (skluh-ROHS-ing) cholangitis (koh-lan-JIE-tis) is a disease of the bile ducts. Bile ducts carry the digestive liquid bile from your liver to your small intestine. In primary sclerosing cholangitis, inflammation causes scars within the bile ducts.

How effective is Ursodeoxycholic acid? ›

Biliary lithogenic index was reduced significantly during treatment with ursodeoxycholic acid, 500 to 600 and 900 to 1000 mg/d. Thus, ursodeoxycholic acid appears to be a safe and effective alternative to surgery in selected patients with gallstones.

Does Ursodeoxycholic acid reduce bilirubin? ›

This reductive effect of UDCA on serum bilirubin levels could be attributed to its ability to induce bile flow, reduce intestinal reabsorption of biliary acids13 and help reduce bilirubin concentration.

What happens if I stop taking Ursodeoxycholic acid? ›

Take this medicine for the full time of treatment, even if you begin to feel better. If you stop taking this medicine too soon, the gallstones may not dissolve as fast or may not dissolve at all.

How fast does ursodeoxycholic acid work? ›

During treatment with ursodiol for dissolution of gallstones, symptoms of biliary distress began to improve after three to six weeks.

What happens if I stop taking ursodeoxycholic acid? ›

Take this medicine for the full time of treatment, even if you begin to feel better. If you stop taking this medicine too soon, the gallstones may not dissolve as fast or may not dissolve at all.

Does ursodiol suppress immune system? ›

Ursodeoxycholic acid has also been shown experimentally to suppress immune response such as immune cell phagocytosis.

What type of drug is ursodeoxycholic acid? ›

Ursodeoxycholic acid is a bile acid used for the treatment of primary biliary cirrhosis (PBC), dissolution of radiolucent gallstones in patients with a functioning gallbladder, and treatment of hepatobiliary disorders associated with cystic fibrosis in pediatric patients.

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