Histopathological study of primary biliary cirrhosis and the effect of ursodeoxycholic acid treatment on histology progression

The semiquantitative histopathological analysis of the liver biopsies obtai ned before and after 4 years of ursodeoxycholic acid (UDCA) therapy in a co hort of primary biliary cirrhosis (PBC) patients is reported. The relations hips between elementary histological lesions before treatment and their pro gression under therapy were assessed. At baseline, two independent groups o f lesions, each of which participate in the development of fibrosis, were i ndividualized, i.e., florid bile duct lesions and ductopenia on one hand an d lymphocytic piecemeal necrosis, ductular proliferation, and lobular necro inflammatory changes on the other hand. Four years of UDCA therapy were ass ociated with a significant decrease in the prevalence of florid interlobula r bile duct (ILBD) lesions, of epithelioid granuloma (P <.001) without any aggravation in the severity of bile duct paucity. Lobular inflammation and necrosis markedly improved (P <.001) whereas the degree of severity of the lymphocytic piecemeal necrosis and ductular proliferation at entry and at 4 years were similar. Worsening of fibrosis was observed in 14 patients (12 of them had a one grade progression) whereas stabilization was noted in 30 of the remaining patients. Severity of both the lymphocytic piecemeal necro sis and lobular inflammation and necrosis at entry was significantly associ ated with the progression of fibrosis. The results suggest that UDCA therap y influences the process leading to bile duct destruction. Patients with se vere lymphocytic piecemeal necrosis and lobular inflammation may need addit ional therapeutic intervention because they have increased risk of fibrosis progression.