END-STAGE PRIMARY BILIARY-CIRRHOSIS IN A FIRST GENERATION MIGRANT SOUTH ASIAN POPULATION

Primary biliary cirrhosis (PBC) is uncommonly described from Asia and it is an extremely rare cause of chronic liver disease in India. Six f irst generation migrant Asian patients with PBC were seen at the Liver Unit, Queen Elizabeth Hospital, Birmingham during the period 1982-94. All were women and their ages at presentation ranged from 31 to 63 (m edian 40) years. All were symptomatic for a median of 6 months prior t o referral to the unit for transplantation. Itching with or without ja undice was a common presenting feature. Diagnosis was based on raised serum IgM levels, presence of antimitochondrial antibody (titres 100-4 00) and diagnostic histology. Only one patient had an associated autoi mmune disease (coeliac disease). Serum bilirubin level was above 100 m u mol/l at the time of presentation in four patients. Four of these pa tients with end-stage PBC are first generation migrants from south Asi a, who have been resident in the West Midlands for the past 10 to 34 y ears. The total south Asian population of the West Midlands is 276 754 ; thus, from these four patients alone the estimated prevalence of PBC in the migrant south Asian population is at least 14 per million. How ever, such data cannot be used to give any accurate assessment of prev alence, for which a population screening programme is required. A high er incidence in the migrant population than in their countries of orig in is compatible with an environmental aetiology.