Ductopenia — the loss of tiny bile ducts in the liver — could be a strong warning sign of worse outcomes in people with primary biliary cholangitis (PBC), according to a study recently published in Frontiers.
What are bile ducts?
Bile ducts are responsible for carrying bile, a fluid that helps digest fats and remove waste from the liver. In PBC, the body’s immune system mistakenly attacks the bile ducts. When these ducts are damaged or disappear, it can lead to scarring, liver failure or the need for a transplant.
The study analyzed data from over 500 people in China who had undergone liver biopsies to confirm their PBC diagnosis. More than half of these patients had already lost a significant number of bile ducts, and about one in four of these patients showed this loss even in the early stages of the disease, before any serious liver damage was apparent.
Read more about PBC testing and diagnosis
Over the course of nearly eight years of follow-up, the researchers found that patients with ductopenia were far more likely to experience serious liver-related complications, including internal bleeding, liver failure or needing a liver transplant. In fact, they were about nine times more likely to have these outcomes than patients whose bile ducts remained intact.
To better identify which patients are at risk early on, the team also looked for patterns in routine blood tests. They found that patients with higher levels of certain markers, including bilirubin, GGT (a liver enzyme) and ANA (an immune system marker), were more likely to have ductopenia. Lower levels of albumin, a protein made by the liver, also signaled a higher risk.
The authors suggest that these four markers could serve as early warning signs of ductopenia and help doctors spot patients at risk before symptoms worsen. The current gold standard for diagnosing duct loss is a liver biopsy, an invasive procedure not often used unless absolutely necessary.
“In conclusion, our study emphasized the important role of ductopenia in the prognosis of PBC, suggesting that doctors should incorporate ductopenia into routine assessments, dynamically integrate histological information (stage/degree of ductopenia) with serum biological markers (GGT, TBIL, ALB, and ANA), comprehensively evaluate the patients’ disease status and progression risk, and optimize the management of patients with PBC,” the authors noted.
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