P1173 - Differences in Diagnosis and Severity of Primary Biliary Cholangitis Across Asian Subcontinents

Neel Matiwala, BS¹, Radhika Patel, MD², Jay Shah, DO, MSc³, Soumojit Ghosh, MD^4
1Saint Louis University School of Medicine, St. Louis, MO; ²SSM Health Saint Louis University Hospital, St. Louis, MO; ³Franciscan Health Olympia Fields, Olympia Fields, IL; ⁴St. Louis University, St. Louis, MO

Introduction: Primary biliary cholangitis (PBC) is an autoimmune, cholestatic, liver disease that presents in middle-aged women. PBC can progress into cirrhosis or liver failure requiring transplant. Ethnicity is one health determinant that can impact access to treatment and hospital mortality. Asian health literature remains limited since studies do not differentiate between subcontinents which skews health outcomes. While PBC incidence is rising in western and East Asian countries, PBC in South Asia remains rare and presents with late-onset severity. The purpose of this review is to evaluate PBC in the South Asian community, and identify factors contributing to its rarity and severe presentation.

Methods: A systematic review of Scopus, CINAHL and PubMed was conducted. Inclusion criteria focused on PBC patients in cohort studies or case reports from Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Patients with overlapped diseases with PBC, patients outside of South Asian descent and studies in non-South Asian countries were excluded. Our search found 10 articles: 7 retrospective studies, 1 prospective study, and 2 case reports.

Results: 80 PBC patients were studied between 1967-2021 with 57 from India, 22 from Pakistan and 1 from Sri Lanka. 7 studies specified sex with 66/67 being female (98.5%). Initial symptoms on presentation included pruritus, jaundice, hepatosplenomegaly, skin changes (hyperpigmentation, xanthelasma and/or vitiligo) and fatigue. 26 patients presented with cirrhosis (32.5%). All studies mentioned using serology, histology and laboratory findings of cholestasis to make the diagnosis; however, the combination varied. 1 study required ⅔ findings suggestive of PBC between serology, histology and cholestasis; 2 studies required liver biopsy. 58/67 patients (86.6%) were positive for antimitochondrial antibodies. 4 studies identified associating autoimmune disease (17/43 patients, 39.5%). No studies mentioned previous smoking history in their patients.

Discussion: PBC literature in South Asian countries is still limited. Our study finds that variation in diagnostic criteria may delay diagnosis leading to its rarity and severity on presentation. Current literature suggests that the increase in PBC incidence globally can be due to environmental toxin exposure and/or smoking, none of which were noted in the South Asian studies. More evidence is needed to discern incidence, prevalence and factors contributing to severity of presentation.


Disclosures:


Neel Matiwala, BS¹, Radhika Patel, MD², Jay Shah, DO, MSc³, Soumojit Ghosh, MD⁴. P1173 - Differences in Diagnosis and Severity of Primary Biliary Cholangitis Across Asian Subcontinents, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.