Laparoscopic Features of Primary Biliary Cirrhosis in AMA-Positive and AMA-Negative Patients

Background and Study Aims: Antimitochondrial antibody (AMA)-negative primary biliary cirrhosis (PBC) has been difficult to diagnose. Laparoscopic features of AMA-negative PBC were evaluated in comparison with those of AMA-positive PBC and autoimmune hepatitis.
Patients and Methods: 71 patients who fulfilled the diagnostic criteria for PBC were enrolled in the study; 48 were AMA-positive and 23 were AMA-negative. As a disease control, 46 autoimmune hepatitis patients were included. Both the frequency and specificity of each laparoscopic finding were evaluated. A laparoscopic scoring system was introduced, which used, common and uncommon laparoscopic findings, and was evaluated for the diagnosis of AMA-negative PBC.
Results: The characteristic laparoscopic findings for AMA-positive PBC were yellowish-white marking (92 %), dark-brown discoloration (73 %), gentle undulation (67 %), reddish patch (38 %), and yellowish-white nodules (32 %). On the other hand, laparoscopic findings such as trench-like depression, reddish markings, and wide and small depressions were uncommon in PBC compared with autoimmune hepatitis. The frequencies of characteristic and uncommon laparoscopic findings did not differ statistically between AMA-positive and AMA-negative PBC, but were different between AMA-positive or AMA-negative PBC and autoimmune hepatitis. Scores based on common and uncommon laparoscopic findings were 5.5 ± 1.5 (mean ± SD) in AMA-positive PBC, 5.6 ± 2.0 in AMA-negative PBC, and - 0.30 ± 0.5 in autoimmune hepatitis.
Conclusion: The laparoscopic findings in AMA-negative PBC did not differ from those of AMA-positive PBC. A laparoscopic scoring system may be helpful in the diagnosis of AMA-negative PBC.

References

• 1 Walker J G, Doniach D, Roitt I M. et al . Serological tests in diagnosis of primary biliary cirrhosis.  Lancet. 1965;  1 827-831
• 2 Bassendine M F. Serological markers of primary biliary cirrhosis; diagnosis, prognosis and subsets.  Hepatology. 1992;  15 545-548
• 3 Yeaman S J, Fussey S PM, Danner D J. et al . Primary biliary cirrhosis; identification of two major M2 mitochondrial autoantigens.  Lancet. 1988;  1 1067-1070
• 4 van de Water J, Gershwin M E, Leung P. et al . The autoepitope of the 74-kD mitochondrial autoantigen of primary biliary cirrhosis corresponds to the functional site of dihydroxylipoamide acetyltransferase.  J Exp Med. 1988;  167 1791-1799
• 5 Leung P, Iwayama T, Prindiville T. et al . Use of recombinant mitochondrial antigens in the diagnosis of primary biliary cirrhosis.  Hepatology. 1992;  15 367-372
• 6 Brunner G, Klinge O. A cholangitis with antinuclear antibodies (immunocholangitis) resembling chronic non suppurative destructive cholangitis.  Dtsch Med Wochenschr. 1987;  112 1454-1458
• 7 Ben-Ari Z, Dhillon P A, Sherlock S. Autoimmune cholangiopathy: part of the spectrum of autoimmune chronic active hepatitis.  Hepatology. 1993;  18 10-15
• 8 Goodman Z D, McNally P R, Davis D R, Ishak K G. Autoimmune cholangitis: a variant form of primary biliary cirrhosis.  Dig Dis Sci. 1995;  40 1232-1242
• 9 Minami Y, Seki K, Nishikawa M. et al . Laparoscopic findings of the liver in the diagnosis of primary biliary cirrhosis: “reddish patch”, a laparoscopic feature in the symptomatic stage.  Endoscopy. 1982;  14 203-208
• 10 Onji M, Yamashita Y, Kato T. et al . Laparoscopic histopathological analysis of “gentle undulation” findings observed in patients with primary biliary cirrhosis.  Endoscopy. 1987;  19 17-19
• 11 Masumoto S, Ninomiya T, Yamauchi Y. et al . Laparoscopic findings in patients with autoimmune cholangiopathy (in Japanese with English abstract).  Gastroenterol Endosc. 1997;  39 1183-1188
• 12 Intractable Hepatitis Research Committee of the Japanese Ministry of Health and Welfare. Diagnostic criteria for primary biliary cirrhosis (in Japanese). 1992
• 13 Tanimizu M, Ukida M, Ito T. et al . Peritoneoscopic findings of autoimmune hepatitis-comparison of hepatitis C virus negative autoimmune hepatitis and hepatitis C virus positive autoimmune hepatitis.  Dig Endosc. 1994;  6 170-175
• 14 Michieletti P, Wanless I R, Katz A. et al . Antimitochondrial antibody negative primary biliary cirrhosis: a distinct syndrome of autoimmune cholangitis.  Gut. 1994;  35 260-265
• 15 Sanchez-Pobre P, Castellano G, Colina F. et al . Antimitochondrial antibody-negative chronic nonsuppurative destructive cholangitis. Atypical primary biliary cirrhosis or autoimmune cholangitis?.  J Clin Gastroenterol. 1996;  23 191-198
• 16 Goodman Z D, McNally P R, Davis D R. et al . Autoimmune cholangitis: a variant of primary biliary cirrhosis. Clinicopathologic and serologic correlations in 200 cases.  Dig Dis Sci. 1995;  40 1232-1242
• 17 Kitami N, Shii H, Shimizu H. et al . Immunoreactivity to M2 proteins in antimitochondrial antibody-negative patients with primary biliary cirrhosis.  J Gastroenterol Hepatol. 1994;  9 7-12
• 18 Tsuneyama K, van de Water J, van Thiel D. et al . Abnormal expression of PDC-E2 on the apical surface of biliary epithelial cells in patients with antimitochondrial antibody-negative primary biliary cirrhosis.  Hepatology. 1995;  22 1440-1446
• 19 Kloppel G, Seifert G, Lindner H. et al . Histopathological features in mixed types of chronic aggressive hepatitis and primary biliary cirrhosis.  Virchow Arch Pathol Anat Histol. 1977;  373 143-160
• 20 Duclos-Vallee J C, Hadengue A, Ganne-Carrie N. et al . Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome.  Dig Dis Sci. 1995;  40 1069-1073