Investigation of patients with anti-mitochondrial antibody positivity and normal alkaline phosphatase levels in terms of primary biliary cholangitis: retrospective analysis

Primary biliary cholangitis (PBK) is a chronic cholestatic liver disease typically diagnosed by high cholestatic liver enzymes and positive antimitocondrial antibody (AMA) testing. The clinical significance of AMA positivity in patients with normal cholestatic liver enzymes is uncertain. Our aim in this study; The aim of this study was to determine the relationship between AMC positivity and PBK in patients with normal cholestatic enzyme levels. Methods: The patients who had AMA and / or AMA-M2 positivity and who applied to Ege University Medical Faculty Gastroenterology Clinic between 2009-2018 were evaluated retrospectively. The laboratory findings, the treatments they received, the diagnoses they followed and the pathology results of the liver biopsies were recorded. Results: 26 patients were included in the study. The mean age of the patients; There were 56.8 ± 14.9 and 23 females (88.46%) and 3 males (11.54%). ALP levels were normal in all patients. AMA-M2 positivity was found in all patients with AMA level IIF or ELISA. A total of 16 patients underwent liver biopsy and 7 (43.75%) had changes consistent with PBK. In the follow-up period, 12 patients were diagnosed with PTC and treated and followed up. AMA titration was detected by IIP in 1/20 and none of the patients were diagnosed with PBK. CONCLUSION: People with positive AMA positivity and normal cholestasis levels are closely related to PBK. AMA titration was diagnosed as at least 2/3 of patients with 1 / 40'. Some of these patients were diagnosed with biopsy and some of them were diagnosed with clinical and laboratory findings. The percentage of female patients in our study group is close to 90% and this finding is similar to the rates seen in patients with PBK. Patients with AMA titration 1/20 were not associated with PBK. In the literature, it is predicted that only 10% of patients with positive AMA level in the general population will develop PBK in the long term. Similar findings were obtained with biopsy-confirmed studies in our study. In this regard; long-term follow-up studies, prospective and retrospective studies are needed. Keywords: primary biliary cholangitis; alkaline phosphatase; anti-mitochondrial antibody