Hispanics With Primary Biliary Cirrhosis Are More Likely to Have Features of Autoimmune Hepatitis and Reduced Response to Ursodeoxycholic Acid Than Non-Hispanics

Cynthia Levy, Jahnavi Naik, Christin Giordano, Amar Mandalia, Christopher B O'Brien, Kalyan R Bhamidimarri, Eugene R Schiff, Paul Martin

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Abstract

Background and Aims: Primary biliary cirrhosis (PBC) is a cholestatic disease that predominantly affects middle-aged Caucasian women. Studies have suggested that PBC has a more aggressive course in individuals of Hispanic ancestry. We investigated the clinical presentation and progression of PBC in an ethnically diverse population. Methods: We performed a cross-sectional study, analyzing data from Hispanic (n= 70) and non-Hispanic patients (n= 134) with PBC seen at the University of Miami/Jackson Memorial Hospital from January 1, 2000, through December 31, 2011. We compared demographics, clinical presentation, response to therapy, and outcomes between the groups. Results: Age at diagnosis, antimitochondrial antibody positivity, frequency of advanced histologic stage, use and dose of ursodeoxycholic acid (UDCA), and the presence of pruritus or fatigue were similar between groups. Hypothyroidism was less frequent among Hispanics (16% vs 29% in non-Hispanics; P= .04). Hispanic subjects were more likely to have overlap syndrome of PBC and autoimmune hepatitis than non-Hispanics (31% vs 13%; P= .002). After a median follow-up period of 3.65 years, a greater percentage of Hispanics had ascites (24% vs 12%; P= .03) and variceal bleeding (20% vs 7%; P= .01), although there were no differences in the number of deaths or liver transplants. Of 204 total patients, 180 received UDCA for at least 1 year. A lower proportion of Hispanic patients had a biochemical response to treatment (60% vs 88%; P < .0001). Independent predictors of poor biochemical response were younger age at diagnosis and Hispanic ethnicity. Conclusions: In a cross-sectional study, patients of Hispanic ethnicity with PBC had an increased prevalence of overlap syndrome, reduced response to UDCA treatment, and more frequent complications of portal hypertension than non-Hispanic patients.

Original languageEnglish
Pages (from-to)1398-1405
Number of pages8
JournalClinical Gastroenterology and Hepatology
Volume12
Issue number8
DOIs
StatePublished - Jan 1 2014

Fingerprint

Ursodeoxycholic Acid
Autoimmune Hepatitis
Biliary Liver Cirrhosis
Hispanic Americans
Cross-Sectional Studies
Portal Hypertension
Pruritus
Hypothyroidism
Ascites
Fatigue
Therapeutics
Demography
Hemorrhage
Transplants
Antibodies
Liver

Keywords

  • Cholestasis
  • Ethnic Origin
  • Health Disparities
  • Prognosis

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

@article{bf7109dcb1304f55b6d7a9f64776c61e,
title = "Hispanics With Primary Biliary Cirrhosis Are More Likely to Have Features of Autoimmune Hepatitis and Reduced Response to Ursodeoxycholic Acid Than Non-Hispanics",
abstract = "Background and Aims: Primary biliary cirrhosis (PBC) is a cholestatic disease that predominantly affects middle-aged Caucasian women. Studies have suggested that PBC has a more aggressive course in individuals of Hispanic ancestry. We investigated the clinical presentation and progression of PBC in an ethnically diverse population. Methods: We performed a cross-sectional study, analyzing data from Hispanic (n= 70) and non-Hispanic patients (n= 134) with PBC seen at the University of Miami/Jackson Memorial Hospital from January 1, 2000, through December 31, 2011. We compared demographics, clinical presentation, response to therapy, and outcomes between the groups. Results: Age at diagnosis, antimitochondrial antibody positivity, frequency of advanced histologic stage, use and dose of ursodeoxycholic acid (UDCA), and the presence of pruritus or fatigue were similar between groups. Hypothyroidism was less frequent among Hispanics (16{\%} vs 29{\%} in non-Hispanics; P= .04). Hispanic subjects were more likely to have overlap syndrome of PBC and autoimmune hepatitis than non-Hispanics (31{\%} vs 13{\%}; P= .002). After a median follow-up period of 3.65 years, a greater percentage of Hispanics had ascites (24{\%} vs 12{\%}; P= .03) and variceal bleeding (20{\%} vs 7{\%}; P= .01), although there were no differences in the number of deaths or liver transplants. Of 204 total patients, 180 received UDCA for at least 1 year. A lower proportion of Hispanic patients had a biochemical response to treatment (60{\%} vs 88{\%}; P < .0001). Independent predictors of poor biochemical response were younger age at diagnosis and Hispanic ethnicity. Conclusions: In a cross-sectional study, patients of Hispanic ethnicity with PBC had an increased prevalence of overlap syndrome, reduced response to UDCA treatment, and more frequent complications of portal hypertension than non-Hispanic patients.",
keywords = "Cholestasis, Ethnic Origin, Health Disparities, Prognosis",
author = "Cynthia Levy and Jahnavi Naik and Christin Giordano and Amar Mandalia and O'Brien, {Christopher B} and Bhamidimarri, {Kalyan R} and Schiff, {Eugene R} and Paul Martin",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.cgh.2013.12.010",
language = "English",
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pages = "1398--1405",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
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T1 - Hispanics With Primary Biliary Cirrhosis Are More Likely to Have Features of Autoimmune Hepatitis and Reduced Response to Ursodeoxycholic Acid Than Non-Hispanics

AU - Levy, Cynthia

AU - Naik, Jahnavi

AU - Giordano, Christin

AU - Mandalia, Amar

AU - O'Brien, Christopher B

AU - Bhamidimarri, Kalyan R

AU - Schiff, Eugene R

AU - Martin, Paul

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background and Aims: Primary biliary cirrhosis (PBC) is a cholestatic disease that predominantly affects middle-aged Caucasian women. Studies have suggested that PBC has a more aggressive course in individuals of Hispanic ancestry. We investigated the clinical presentation and progression of PBC in an ethnically diverse population. Methods: We performed a cross-sectional study, analyzing data from Hispanic (n= 70) and non-Hispanic patients (n= 134) with PBC seen at the University of Miami/Jackson Memorial Hospital from January 1, 2000, through December 31, 2011. We compared demographics, clinical presentation, response to therapy, and outcomes between the groups. Results: Age at diagnosis, antimitochondrial antibody positivity, frequency of advanced histologic stage, use and dose of ursodeoxycholic acid (UDCA), and the presence of pruritus or fatigue were similar between groups. Hypothyroidism was less frequent among Hispanics (16% vs 29% in non-Hispanics; P= .04). Hispanic subjects were more likely to have overlap syndrome of PBC and autoimmune hepatitis than non-Hispanics (31% vs 13%; P= .002). After a median follow-up period of 3.65 years, a greater percentage of Hispanics had ascites (24% vs 12%; P= .03) and variceal bleeding (20% vs 7%; P= .01), although there were no differences in the number of deaths or liver transplants. Of 204 total patients, 180 received UDCA for at least 1 year. A lower proportion of Hispanic patients had a biochemical response to treatment (60% vs 88%; P < .0001). Independent predictors of poor biochemical response were younger age at diagnosis and Hispanic ethnicity. Conclusions: In a cross-sectional study, patients of Hispanic ethnicity with PBC had an increased prevalence of overlap syndrome, reduced response to UDCA treatment, and more frequent complications of portal hypertension than non-Hispanic patients.

AB - Background and Aims: Primary biliary cirrhosis (PBC) is a cholestatic disease that predominantly affects middle-aged Caucasian women. Studies have suggested that PBC has a more aggressive course in individuals of Hispanic ancestry. We investigated the clinical presentation and progression of PBC in an ethnically diverse population. Methods: We performed a cross-sectional study, analyzing data from Hispanic (n= 70) and non-Hispanic patients (n= 134) with PBC seen at the University of Miami/Jackson Memorial Hospital from January 1, 2000, through December 31, 2011. We compared demographics, clinical presentation, response to therapy, and outcomes between the groups. Results: Age at diagnosis, antimitochondrial antibody positivity, frequency of advanced histologic stage, use and dose of ursodeoxycholic acid (UDCA), and the presence of pruritus or fatigue were similar between groups. Hypothyroidism was less frequent among Hispanics (16% vs 29% in non-Hispanics; P= .04). Hispanic subjects were more likely to have overlap syndrome of PBC and autoimmune hepatitis than non-Hispanics (31% vs 13%; P= .002). After a median follow-up period of 3.65 years, a greater percentage of Hispanics had ascites (24% vs 12%; P= .03) and variceal bleeding (20% vs 7%; P= .01), although there were no differences in the number of deaths or liver transplants. Of 204 total patients, 180 received UDCA for at least 1 year. A lower proportion of Hispanic patients had a biochemical response to treatment (60% vs 88%; P < .0001). Independent predictors of poor biochemical response were younger age at diagnosis and Hispanic ethnicity. Conclusions: In a cross-sectional study, patients of Hispanic ethnicity with PBC had an increased prevalence of overlap syndrome, reduced response to UDCA treatment, and more frequent complications of portal hypertension than non-Hispanic patients.

KW - Cholestasis

KW - Ethnic Origin

KW - Health Disparities

KW - Prognosis

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