Abstract
<h3>Introduction</h3> Primary Biliary Cholangitis (PBC) is a chronic, progressive disorder, with a relatively well-tolerated treatment option in the form of Ursodeoxycholic acid. A confident diagnosis of PBC relies upon a positive anti-mitochondrial antibody (AMA), a raised alkaline phosphatase (ALP) and/or immunoglobulin M (IgM). York Teaching Hospitals NHS Foundation Trust (YTHT) serves a population of 800,000<sup>1</sup>, however our existing PBC database included only 100 patients. Given the prevalence (35 per 100,000<sup>2</sup>) it is likely there are a significant number of undiagnosed cases within our population. <h3>Aim</h3> To review historical positive AMA tests throughout YTHT, with the aim of identifying patients with hitherto undiagnosed PBC. <h3>Method</h3> An IT-based search identified all positive AMA blood tests over a nine year period (2009–2018) (n = 731). An electronic note review of a proportion (n = 204) established demographic details, blood test results (including liver blood tests and immunoglobulins), the department requesting the test and consequential action taken. <h3>Results</h3> Data from 2017–18 revealed 204 patients with a positive AMA, 88% of whom were female. Tests were predominantly requested by specialties other than hepatology; secondary care specialties (52%) GPs (38%) and hepatologists (9%). 34% had a known diagnosis of PBC. 31% of the cohort had a raised ALP (ALP >130 IU/L). Of those patients in whom immunoglobulins were performed (n = 112) over half, 57%, had a positive IgM. 115 patients (56%) had a positive AMA only, of these hepatology advice was sought in less than half (44%) of cases. 19 patients (9%) had results in keeping with a diagnosis of PBC, but were not referred, or previously known to, the hepatology service. <h3>Discussion</h3> Our results have identified a significant number of patients in this population with undiagnosed PBC who could benefit from treatment. Identifying patients who potentially have established PBC is relatively non-invasive, and form part of the panel of blood tests frequently requested in primary and secondary care. As many such patients do not end up with either a formal diagnosis or appropriate referral, perhaps it is time to recommend all hospitals interrogate their laboratory databases in this way. <h3>Reference</h3> www.yorkhospitals.nhs.uk/about-us/ Hirschfield GM, Dyson JK, Alexander GJM, <i>et al</i>. The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines. <i>Gut</i> 2018;<b>67</b>:1568–1594
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