Familial idiopathic adulthood ductopenia: a report of five cases in three generations

Background/Aims: Idiopathic adulthood ductopenia is a cholestatic liver dis ease of unknown etiology. Although most cases are sporadic, familial cases do occur. Methods: We describe a series of adult-onset bile duct depletion involving five members of an extended family spanning three generations. The proband, a 49-year-old man, presented in 1989 with asymptomatic elevation of liver enzyme tests, Investigations for chronic liver disease, including endoscopi c retrograde cholangiopancreatography, were negative. Findings on liver bio psy progressed from normal in 1989 to striking loss of interlobular bile du cts in 1992. Ursodeoxycholic acid has resulted in improvement of liver enzy me tests, The proband's brother required a liver transplant at age 35 for c ryptogenic cirrhosis. The proband's sister, age 42, has had intermittent ja undice and elevation of liver enzyme tests since 1971. Her liver biopsy fin dings progressed from normal in 1975, to striking bile duct damage by 1997, The proband's 21-year-old son has elevated liver enzyme tests and a liver biopsy consistent with idiopathic adulthood ductopenia, The proband's fathe r had a liver biopsy at age 70 for investigation of a liver mass, It reveal ed extensive fibrosis and striking bile duct destruction, Results/Conclusions: This is the largest series of familial idiopathic adul thood ductopenia reported, and the first with multiple generations describe d, Genetics appears to play a role in some cases of adulthood ductopenia, U rsodeoxycholic acid may be beneficial in the treatment of this condition.