Año 2021 / Volumen 113 / Número 11
Original
Retrieval and treatment of patients with primary biliary cholangitis who are lost in the health system

776-779

DOI: 10.17235/reed.2021.8174/2021

Antonio Olveira-Martín, Jorge Yebra-Carmona, Carla Amaral-González, Marta Tejedor, Pablo Eirás, María Hernández-Pérez, Carolina Suárez-Cabredo, Isabel Spigarelli-de Rábago, Cristina Suárez-Ferrer, Dalia Morales-Arráez, Inmaculada Chico, Felicitas Díaz-Flores, Raquel Rodríguez, Silvia Llorente, Esther Molina-Pérez, Manuel Nicolás Hernández-Guerra de Aguilar,

Resumen
Introduction: hepatitis C patients loss to follow-up in the health care system has been shown to have negative consequences. This study aimed to investigate this issue as regards primary biliary cholangitis. Methods: the databases (immunology, biochemistry, clinical reports, drug dispensation, appointments) of 4 reference hospitals in Spain (serving a population of 1,450,000 inhabitants) were analyzed. The diagnosis of primary biliary cholangitis was based on an antimitochondrial antibody titer ≥ 1:80, chronically elevated alkaline phosphatase, and the absence of other liver disease. Patients were classified as lost in the absence of reports indicating a diagnosis, specific medical follow-up, and/or treatment with bile salts. Results: a total of 1372 patients with antimitochondrial antibody titers ≥ 1:80 were included between January 2010 and June 2019. A total of 697 (50.8 %) were classified as having primary biliary cholangitis, and 100 patients (14.3 %; 95 % CI: 11.8-17.2) were identified as lost. Of these, 30 were contacted and retrieved. The median age was 70 years, 93 % were female, median alkaline phosphatase was 185 IU/L, 10 % had pruritus, and 27 % had a transient elastography value > 9.5 kPa. The disease was confirmed and ursodeoxycholic acid was started in all 30 patients. Death was liver-related in 6 of the 100 patients classified as lost. Conclusion: up to 14.3 % of patients (1 out of 7) with a definitive diagnosis of primary biliary cholangitis remain undiagnosed, thus preventing monitoring and treatment. More than a quarter are at risk of advanced liver disease and its complications. Patients lost in the system must be identified and retrieved, and searching hospital databases is a suitable approach to meet this goal.
Share Button
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. J Hepatol 2017;67:145-72.
2. Hirschfield GM, Dyson JK, Alexander GJM, et al. The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines. Gut 2018;67:1568-94.
3. Alvaro D, Carpino G, Craxi A, et al. Primary biliary cholangitis management: controversies, perspectives, and daily practice implications from an expert panel. Liver Int 2020;00:1-12.
4. Harms HM, van Buuren HR, Corpechot C, et al. Ursodeoxycholic acid therapy and liver transplant-free survival in patients with primary biliary cholangitis. J Hepatol 2019;71:357-65.
5. Nevens F, Andreone P, Mazzella G, et al. A placebo-controlled trial of obeticholic acid in primary biliary cholangitis. N Engl J Med 2016;375:631-43.
6. Bowlus CL, Pockros PJ, Kremer AE, et al. Long-term obeticholic acid therapy improves histological endpoints in patients with primary biliary cholangitis. Clin Gastroenterol Hepatol 2020;18:1170-8.
7. Corpechot C, Chazouillères O, Rousseau A, et al. A placebo-controlled trial of bezafibrate in primary biliary cholangitis. N Engl J Med 2018;378:2171-81.
8. Reig A, Sesé P, Parés A. Effects of bezafibrate on outcome and pruritus in primary biliary cholangitis with suboptimal ursodeoxycholic acid response. Am J Gastroenterol 2018;113:49-55.
9. Floreani A, Caroli D, Variola A, et al. A 35-year follow-up of a large cohort of patients with primary biliary cirrhosis seen at a single centre. Liver Int 2011;31:361-8.
10. Pla X, Vergara M, Gil M, et al. Incidence, prevalence and clinical course of primary biliary cirrhosis in a Spanish community. Eur J Gastroenterol Hepatol 2007;19:859-64.
11. Lieveld FI, Arends JE, Amelung L, et al. Overcoming outpatient loss to follow-up as a barrier to efficiently instituting hepatitis B liver-related care. Clin Infect Dis 2017;64:233-5.
12. Beekmans N, Klemt-Kropp M. Re-evaluation of chronic hepatitis B and hepatitis C patients lost to follow-up: results of the Northern Holland hepatitis retrieval project. Hepatol Med Policy 2018;3:5.
13. Balkhy HH, El-Saed A, Sanai FM, et al. Magnitude and causes of loss to follow-up among patients with viral hepatitis at a tertiary care hospital in Saudi Arabia. J Infect Public Health 2017;10:379-87.
14. Kracht PAM, Arends JE, van Erpecum KJ, et al. REtrieval And cure of Chronic Hepatitis C (REACH): Results of micro‐elimination in the Utrecht province. Liver Int 2019;39:455-62.
15. Simpson H, Manley P, Lawler J, et al. Distance to treatment as a factor for loss to follow up of hepatitis C patients in North East England. J Public Health (Oxf) 2019;41:700-6.
16. Mulligan K, Sullivan J, Yoon L, et al. Evaluating HCV screening, linkage to care, and treatment across insurers. Am J Manag Care 2018;24:257-64.
17. Nouch S, Gallagher L, Erickson M, et al. Factors associated with lost to follow-up after hepatitis C treatment delivered by primary care teams in an inner-city multi-site program, Vancouver, Canada. Int J Drug Policy 2018;59:76-84.
18. Andaluz I, Arcos MM, Montero MD, et al. Patients with hepatitis C lost to follow-up: ethical-legal aspects and search results. Rev Esp Enferm Dig 2020;112:532-7.
19. Poupon R, Chrétien Y, Poupon RE, et al. Is ursodeoxycholic acid an effective treatment for primary biliary cirrhosis? Lancet 1987;1:834-6.
20. Hempfling W, Dilger K, Beuers U. Systematic review: ursodeoxycholic acid adverse effects and drug interactions. Aliment Pharmacol Ther 2003;18:963-72.
21. Morales-Arráez D, Hernández-Guerra M. Electronic alerts as a simple method for amplifying the yield of hepatitis C virus infection screening and diagnosis. Am J Gastroenterol 2020;115:9-12.
Artículos relacionados

Caso Clínico

The clinical extremes of autoimmune cholangitis

DOI: 10.17235/reed.2017.4167/2015

Instrucciones para citar
Olveira-Martín A, Yebra-Carmona J, Amaral-González C, Tejedor M, Eirás P, Hernández-Pérez M, et all. Retrieval and treatment of patients with primary biliary cholangitis who are lost in the health system. 8174/2021


Descargar en un gestor de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica
Este artículo ha sido visitado 1548 veces.
Este artículo ha sido descargado 244 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 22/06/2021

Aceptado: 04/08/2021

Prepublicado: 02/09/2021

Publicado: 05/11/2021

Tiempo de revisión del artículo: 41 días

Tiempo de prepublicación: 72 días

Tiempo de edición del artículo: 136 días


Compartir
Este artículo ha sido valorado por 1 lectores .
Valoración del lector:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
La REED es el órgano oficial de la Sociedad Española de Patología Digestiva, la SociedadEspañola de Endoscopia Digestiva y la Asociación Española de Ecografía Digestiva
Política de cookies Política de Privacidad Aviso Legal © Copyright 2023 y Creative Commons. Revista Española de Enfermedades Digestivas