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In primary biliary cholangitis, concurrent NAFLD stands out as a paradox—unchanging drug response yet linked to reduced fibrosis and superior long-term survival.
Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as a silent disruptor of liver health, and its intersection with primary biliary cholangitis (PBC) raises critical questions about how it shapes disease progression and prolonged prognosis. This retrospective study by Wenhui Ren et al. aimed to investigate the influence of NAFLD on the progression and prognosis of PBC. Researchers reviewed patients with PBC and identified those with coexisting NAFLD using the latest 2023 American Association for the Study of Liver Diseases (AASLD) guidelines.
The team measured treatment response through biochemical markers defined by the Paris criteria, while liver fibrosis was assessed using non-invasive scoring systems. Long-term prognosis was evaluated with a transplant-free survival model, and robust statistical methods were applied to ensure reliable comparisons. The results showed that out of 363 patients identified with PBC, 87 (24%) were confirmed with NAFLD. The likelihood of achieving a complete biochemical response to ursodeoxycholic acid (UDCA) did not differ markedly between patients with PBC alone and those with concurrent NAFLD (P > 0.05).
Remarkably, after 1 year of UDCA therapy, patients with both PBC and NAFLD illustrated very low fibrosis scores compared to those with PBC alone, as measured by the aspartate aminotransferase-to-platelet ratio index (APRI, 0.35 vs. 0.47, P = 0.02) and the fibrosis-4 (FIB-4) score (1.95 vs. 2.53, P = 0.01). Long-term outcomes assessed via the GLOBE score revealed that the PBC–NAFLD group had higher liver transplant-free survival at 5, 10, and 15 years (81.9%, 58.3%, and 38.0%, respectively; all P < 0.05), suggesting a striking survival benefit in NAFLD sufferers.
The study revealed that, although concurrent NAFLD did not modify the biochemical response to UDCA in PBC patients, it was associated with attenuated liver fibrosis and improved long-term transplant-free survival, suggesting a paradoxical yet potentially protective role of NAFLD in shaping the disease trajectory.
BMC Gastroenterology
Concurrent nonalcoholic fatty liver disease may decrease liver fibrosis severity in patients with primary biliary cholangitis
Wenhui Ren et al.
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