An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities

Darius Sorbi, Douglas B. McGill, Johnson L. Thistle, Terry M Therneau, Jessica Henry, Keith D. Lindor

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

OBJECTIVE: The role of liver biopsy in the management of patients with nonspecific chronic liver enzyme abnormalities is not well established. The aim of this study is to determine whether liver histology changes the clinical impression formed before liver biopsy and the preliminary management plan. METHODS: Consenting asymptomatic adult patients with persistent (≥6 months) liver test abnormalities were enrolled. Patients with a strong suspicion for a specific liver disease were excluded. A presumptive diagnosis and a preliminary management plan were documented before a liver biopsy. After the liver biopsy, the patients were reassessed to determine the effect of the biopsy on the diagnosis and management plan. RESULTS: A total of 36 patients were enrolled: 15 men and 21 women, with a median age of 51 yr. The prebiopsy diagnoses were nonalcoholic steatohepatitis (24), autoimmune hepatitis (3), primary biliary cirrhosis (2), primary sclerosing cholangitis (2), and miscellaneous (5 patients). The liver biopsy changed the diagnosis in 14% of cases. Lifestyle recommendations were not significantly altered by the biopsy. The liver biopsy affected the frequency of liver test monitoring in 13 patients (36%). Treatment recommendations were affected in 12 cases, 10 of whom were offered investigational therapy. CONCLUSIONS: Although a liver biopsy may help to definitively establish the final diagnosis in patients, the results alter the presumptive prebiopsy diagnosis infrequently, and no proven therapy exists for the vast majority of these patients. Therefore, the risks and benefits of a liver biopsy should be carefully weighed, especially in settings in which investigational therapies are unavailable. (C) 2000 by Am. Coll. of Gastroenterology.

Original languageEnglish (US)
Pages (from-to)3206-3210
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume95
Issue number11
DOIs
StatePublished - 2000

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Biopsy
Liver
Investigational Therapies
Autoimmune Hepatitis
Sclerosing Cholangitis
Gastroenterology
Life Style
Liver Diseases
Histology
Enzymes
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities. / Sorbi, Darius; McGill, Douglas B.; Thistle, Johnson L.; Therneau, Terry M; Henry, Jessica; Lindor, Keith D.

In: American Journal of Gastroenterology, Vol. 95, No. 11, 2000, p. 3206-3210.

Research output: Contribution to journalArticle

Sorbi, Darius ; McGill, Douglas B. ; Thistle, Johnson L. ; Therneau, Terry M ; Henry, Jessica ; Lindor, Keith D. / An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities. In: American Journal of Gastroenterology. 2000 ; Vol. 95, No. 11. pp. 3206-3210.
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abstract = "OBJECTIVE: The role of liver biopsy in the management of patients with nonspecific chronic liver enzyme abnormalities is not well established. The aim of this study is to determine whether liver histology changes the clinical impression formed before liver biopsy and the preliminary management plan. METHODS: Consenting asymptomatic adult patients with persistent (≥6 months) liver test abnormalities were enrolled. Patients with a strong suspicion for a specific liver disease were excluded. A presumptive diagnosis and a preliminary management plan were documented before a liver biopsy. After the liver biopsy, the patients were reassessed to determine the effect of the biopsy on the diagnosis and management plan. RESULTS: A total of 36 patients were enrolled: 15 men and 21 women, with a median age of 51 yr. The prebiopsy diagnoses were nonalcoholic steatohepatitis (24), autoimmune hepatitis (3), primary biliary cirrhosis (2), primary sclerosing cholangitis (2), and miscellaneous (5 patients). The liver biopsy changed the diagnosis in 14{\%} of cases. Lifestyle recommendations were not significantly altered by the biopsy. The liver biopsy affected the frequency of liver test monitoring in 13 patients (36{\%}). Treatment recommendations were affected in 12 cases, 10 of whom were offered investigational therapy. CONCLUSIONS: Although a liver biopsy may help to definitively establish the final diagnosis in patients, the results alter the presumptive prebiopsy diagnosis infrequently, and no proven therapy exists for the vast majority of these patients. Therefore, the risks and benefits of a liver biopsy should be carefully weighed, especially in settings in which investigational therapies are unavailable. (C) 2000 by Am. Coll. of Gastroenterology.",
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