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Alkaline phosphatase normalization is associated with better prognosis in primary sclerosing cholangitis

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Authors
Stanich, Peter P
Bjornsson, Einar
Gossard, Andrea A
Enders, Felicity
Jorgensen, Roberta
Lindor, Keith D
Issue Date
2011-04

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Dig Liver Dis. 2011, 43(4):309-13
Abstract
BACKGROUND: Primary sclerosing cholangitis results in elevated but fluctuating serum alkaline phosphatase levels that occasionally return to normal. AIMS: To investigate the frequency of normalization of alkaline phosphatase in newly diagnosed primary sclerosing cholangitis patients and the subsequent clinical outcomes. METHODS: Records of newly diagnosed primary sclerosing cholangitis patients were examined retrospectively for laboratory values and clinical end points (cholangiocarcinoma, liver transplantation and death) within 10 years of diagnosis. Data from a recent prospective ursodeoxycholic acid treatment trial were also studied. RESULTS: Eighty-seven patients met the inclusion criteria. Normalization of alkaline phosphatase was seen in 35 (40%) patients. Five (14%) patients with normalization reached an end point whereas 17 (33%) of the patients with persistent elevation reached an end point (P=0.02). Ursodeoxycholic acid was used similarly by both groups. When the investigative criteria were applied to a prospective trial, there was again a significant relationship between normalization of alkaline phosphatase and survival in patients receiving ursodeoxycholic acid (P<0.01) and the placebo group (P=0.02). CONCLUSIONS: Serum alkaline phosphatase was found to normalize in a high proportion of newly diagnosed primary sclerosing cholangitis patients. This was significantly associated with a better prognosis in a retrospective cohort and when data from a prospective treatment trial was evaluated.
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http://dx.doi.org/10.1016/j.dld.2010.12.008
ae974a485f413a2113503eed53cd6c53
10.1016/j.dld.2010.12.008
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