BIOCHEMICAL AND HISTOLOGICAL-CHANGES AFTER MORE THAN 4 YEARS OF TREATMENT OF URSODEOXYCHOLIC ACID IN PRIMARY BILIARY-CIRRHOSIS

We report on three patients with symptomatic, anicteric, and noncirrho tic primary biliary cirrhosis (Ludwig histological stage III at first liver biopsy) who were treated orally with 600 mg/day of ursodeoxychol ic acid (UDCA) for more than 4 years. Follow-up liver biopsy was perfo rmed twice (at 1-3 and 4-6 years) during treatment. In all cases, duri ng the whole period of up to 4-6 years of UDCA treatment, transaminase , alkaline phosphatase, and gamma-glutamyltranspeptidase levels improv ed, remaining at subnormal levels compared with pretreatment levels. M oreover, histological stage did not change throughout the UDCA treatme nt of up to 6 years. The second liver biopsy (at 1-3 years) revealed d ecreased lymphocytic infiltration in all cases, and bridging fibrosis was decreased in two cases. However, in the third biopsy at 4-6 years, portal inflammation was increased in one case without fibrotic progre ssion; in the other two cases, bridging fibrosis was slightly worsened without portal inflammatory progression. In summary, these three case s show that liver histology was found to be improved, as were blood ch emistry and pruritus, during short-term UDCA treatment, but histology results were slightly worse after long-term treatment despite the sust ained improvement in biochemistry and pruritus.