THE NATURAL-HISTORY OF ABDOMINAL-PAIN ASSOCIATED WITH PRIMARY BILARY CIRRHOSIS

Objectives: The aim of the present study was to determine the prevalen ce and natural history of abdominal pain in patients with primary bili ary cirrhosis. Methods: We studied 178 patients with well-defined prim ary biliary cirrhosis enrolled in a prospective randomized trial of ur sodeoxycholic acid. These patients underwent upper endoscopy and upper abdominal ultrasound prior to entry, at 2 yr, and as indicated. Fourt een patients had additional evaluations including abdominal CT (four), colon x-ray (five), colonoscopy (three), endoscopic retrograde cholan giopancreatography (two), and upper gastrointestinal x-ray (two). Resu lts: Patients with abdominal pain generally presented with right upper quadrant discomfort. Thirty-one patients (17%) had pain at study entr y: 33% of these had pain persisting at 1 yr, and 20% of these had pain persisting at 2 yr. The resolution of pain was not clearly affected b y ursodeoxycholic acid. Evaluation with ultrasound and upper endoscopy found four patients with asymptomatic cholelithiasis, one with esopha geal erosions, four with gastric erosions, one with a gastric ulcer, a nd two with duodenal erosions. Additional tests were unrevealing in 14 patients. Patients with pain were similar to patients without pain wi th regard to age, histological stage, gender, and liver biochemistries . Conclusions: We conclude that chronic right upper quadrant pain is n ot uncommon in patients with primary biliary cirrhosis, that it usuall y resolves spontaneously, and that upper endoscopy is the most importa nt diagnostic test to use to exclude treatable causes of pain.