Cross post from UC board; liver biopsy coming up

Hi guys! Below is my post from the UC board (had it for just under 5 years). Nothing's been diagnosed liver wise, but anyone who's been through this or can tell me what to expect please chime in:

I've had some unfortunate results in bloodwork lately that's leading to a liver biopsy in a few days. I'm trying not to google too much until I know what's going on, but I've found psc has a strong connection with uc. Doctor said they are specifically looking for pbc or autoimmune hepatitis (viral heps are neg). Any insight? Anyone diagnosed with one of these? Or better, anyone do the biopsy and have nothing wrong (with positive ANAs and elevated smooth muscle antibodies)?


All I really know is enzymes are elevated, sma is 25 (should be below 20), ANA is positive and viral hepatitis b&c are negative. I'm on remicade now, quit imuran after only a few doses from a bad reaction about 8 weeks ago. I appreciate any and all help :)

Thanks-the waiting is definitely difficult, as I know from waiting on all my uc drugs to work.

I'm hoping someone will say it'll be fine, is probably med induced and will clear up, but I guess then they wouldn't frequent the hepatitis board ;) And the uc board has no responses of similar cases so far. Anyone add whatever you feel is necessary. I was on Pred from April 2012-July 2013, so I guess part of me is thinking if it's AIH it would've been masked for that 15+ months

It can be difficult to tell if the problem is AIH, PSC or PBC (or none of these) from blood tests so a biopsy seems the best way forward. Have you had an MRCP scan? To complicate matters further there are some overlap syndromes when people have signs of two different diseases. But it is important to get the correct diagnosis as steroids are needed in AIH but don't help PBC or PSC (at least I don't think they help PSC but certainly are of no use in PBC). As Sean says ursodeoxycholic acid (urso for short!) is very useful when treating PBC and PSC but not usually effective treating AIH and so on.

I have had AIH for 14 years and am now being investigated for possible overlap with PBC or (my hep thinks less likely) PSC. I get the biopsy results this week. The MRCP was inconclusive hence the biopsy.

What are your readings for ALT, ALP and GGT do you know?

Good luck with the biopsy. Take a good book! Although precise protocols vary, most liver biopsies require a few hours of lying down which can be very tedious.

Good luck.

Ann

I share your views on steroids! The good news is that most people (about 60%) are able to control their AIH long term without steroids. They work quickly which is why they are used initially but then other immunosuppressants are used and the steroids reduced, often to zero. I too reacted to azathioprine but am now on mycophenolate and no steroids. When I had a flare I took budesonide rather than pred.

Biopsy results vary in the time taken. Mine have taken a few weeks this time because my hep wanted a specific pathologist to do the report and he has been on holiday. Ask when you have your biopsy.

However, you are getting ahead of yourself and perhaps worrying unnecessarily. So take a step at a time.

Ann

Post Edited By Moderator (hep93) : 9/21/2013 12:56:35 PM (GMT-6)

Thanks guys :) I'm not pulling my hair out or anything, I just don't appreciate the unknown! I know autoimmune diseases aren't the end of the world, but my uc has been flaring for over 17months now, so I know there are bad spells. I will come back in a few weeks with an outcome, and will hang out longer if AIH is the culprit :)