[Usefulness of autoantibodies in the study of autoimmune liver diseases and prevalence of autoimmune extrahepatic manifestations]. / Utilidad de los autoanticuerpos en el estudio de las enfermedades hepáticas autoinmunes y prevalencia de manifestaciones extrahepáticas autoinmunes.

BACKGROUND: Autoantibodies are prominent findings in the diagnosis of autoimmune liver diseases. However, their usefulness is limited due to the high reported prevalence in others nonautoimmune disorders. The purpose of this report was to assess the significance of these markers in patients with autoimmune liver diseases and to determine the prevalence of extrahepatic autoimmune phenomena. METHODS: We evaluated the samples from all the patients with altered biochemical liver parameters (ALT, AST, alkaline phosphatase or bilirubin) and a complete profile of autoimmunity [Anti-nuclear (ANA), anti-mitocondrial (AMA), anti-smooth muscle (SMA) and anti-liver/kidney microsomes (LKM1) antibodies] received in the Immunology Laboratory from 1993 to 1996. The records of the patients with at least one positive serologic marker were retrospectively reviewed. Autoimmune liver diseases (Autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC) and Overlap syndromes) were diagnosed according to composite clinical, analytical, histological or response-to-treatment parameters. RESULTS: Samples from 548 patients were analyzed. Of these 85 (15.5%) were positive for at least one antibody. Disorders and autoantibodies were: Autoimmune liver diseases: 18 (4 AIH, 11 PBC, 3 Overlap syndromes); alcohol-induced liver disease: 14 (5 ANA, 9 SMA), Chronic HCV infection: 28 (9 ANA, 17 SMA, 2 ANA + SMA), Chronic HCV + AIH: 2 (1 ANA, 1 ANA + SMA); other liver diseases: 7 (4 ANA, 1 AMA, 2 SMA); other diseases with liver involvement: 10 (8 ANA, 2 SMA); no liver disease (normal): 6 (3 ANA, 1 AMA, 2 SMA). In 75% (64/85) of the positivities processes regarded as immunological liver disease were not found. We identified in 12 out of 20 patients with autoimmune liver diseases others autoimmune extrahepatic processes; in 4 before a diagnosis of liver disease was made. CONCLUSIONS: Autoimmune serologic markers are useful in the study of liver diseases. However, due to inespecifity each individual patient deserves a careful evaluation. Autoimmune extrahepatic manifestations are often found and in some cases allow to recognize the hepatic involvement.

[Recurrent pyogenic cholangitis in a western patient]. / Colangitis piógena recurrente en un paciente occidental.

Recurrent pyogenic cholangitis, or oriental cholangiohepatitis, is highly prevalent in Southeast Asia where it is a common cause of attendance at emergency centers. Sporadic cases have been described outside these areas, especially in asian immigrants but its appearance in westerners is exceptional. We present a case of this disease in a western patient and discuss aspects of its diagnosis and therapy.

[Biliopancreatic ascariasis: an infrequent disease in our environment]. / Ascariasis biliopancreática: una entida infrecuente en nuestro medio.

Ascariasis is one of the most frequent helminthic diseases in man. Most cases follow a subclinical form but may show symptoms related to pulmonary hypersensitivity or digestive complications. Although biliopancreatic complications have been widely described in endemic areas, references in Western countries are scarce. The authors therefore report their experience in 3 cases of this infrequent disease which were recently attended in their hospital over a brief period of time.