Prevalence and incidence of primary biliary cirrhosis are increasing in Finland

Department of Oral Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
Scandinavian Journal of Gastroenterology (Impact Factor: 2.36). 11/2007; 42(11):1347-53. DOI: 10.1080/00365520701396034
Source: PubMed


To examine the epidemiology of primary biliary cirrhosis (PBC) in Finland and to evaluate whether the possible increase in prevalence was attributable to the increasing incidence, better survival, or both.
The Hospital Discharge Register, pathology registers, and death certificates for the years 1988 99 were scrutinized, and the patients identified were followed-up for survival until 31 October 2004. The study area covered four university hospital districts: a total of 25 hospitals. The diagnosis of PBC was regarded as definite (or probable) if three (or two) of the following criteria were fulfilled: positive antimitochondrial antibodies, constantly elevated alkaline phosphatase, and compatible liver histology.
In the total population of the study areas, the age-standardized prevalence of PBC increased during the study period from 103 (95% CI: 97-110) to 180 (172-189) per million inhabitants. Incidence increased from 12 (10-14) to 17 (15-20) per million inhabitants per year. The annual average increase in prevalence was 5.1% (4.2-5.9%, p <0.0001) and in incidence 3.5% (0.9%-6.0%, p =0.008). In gender-specific analyses among women, the prevalence of PBC increased from 161 (151-171) to 292 (277-207) per million during the study period and the incidence from 20 (16-24) to 27 (23-32) per million per year. The death rate was 4% per year and half the deaths were from liver-related causes. Survival after diagnosis during the study period lengthened.
The prevalence of PBC increased in Finland during 1988-99, owing to both the increased incidence and the prolonged survival.

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    • "Primary biliary cirrhosis (PBC) is a liver specific autoimmune disease. The incidence of PBC is 2.7 per 100,000 in a well defined US population [14] but varies between geographic locations [15] [16]. PBC is more prevalent in Northern Europe and North America and less common in Eastern Asia, Africa, and Australia [17] [18]. "
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    ABSTRACT: Environmental stimulation is a major factor in the initiation and perpetuation of autoimmune diseases. We have addressed this issue and focused on primary biliary cirrhosis (PBC), an autoimmune disease of the liver. Immunologically, PBC is distinguished by immune mediated destruction of the intra hepatic bile ducts and the presence of high titer antimitochondrial autoantibodies (AMA) directed against a highly specific epitope within the lipoic acid binding domain of the pyruvate dehydrogenase E2 subunit (PDC-E2). We submit that the uniqueness of AMA epitope specificity and the conformational changes of the PDC-E2 lipoyl domain during physiological acyl transfer could be the lynchpin to the etiology of PBC and postulate that chemical xenobiotics modification of the lipoyl domain of PDC-E2 is sufficient to break self-tolerance, with subsequent production of AMA in patients with PBC. Indeed, using quantitative structure activity relationship (QSAR) analysis on a peptide-xenobiotic conjugate microarray platform, we have demonstrated that when the lipoyl domain of PDC-E2 was modified with specific synthetic small molecule lipoyl mimics, the ensuing structures displayed highly specific reactivity to PBC sera, at levels often higher than the native PDC-E2 molecule. Hereby, we discuss our recent QSAR analysis data on specific AMA reactivity against a focused panel of lipoic acid mimic in which the lipoyl di-sulfide bond are modified. Furthermore, data on the immunological characterization of antigen and Ig isotype specificities against one such lipoic acid mimic; 6,8-bis(acetylthio)octanoic acid (SAc), when compared with rPDC-E2, strongly support a xenobiotic etiology in PBC. This observation is of particular significance in that approximately one third of patients who have taken excessive acetaminophen (APAP) developed AMA with same specificity as patients with PBC, suggesting that the lipoic domain are a target of APAP electrophilic metabolites such as NAPQI. We submit that in genetically susceptible hosts, electrophilic modification of lipoic acid in PDC-E2 by acetaminophen or similar drugs can facilitate loss of tolerance and lead to the development of PBC.
    Full-text · Article · Jan 2013 · Journal of Autoimmunity
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    • "Study, yr [Ref.] of study population Case- Case- ascertainment Chong et al., 2010 [43] + + + Myers et al., 2009 [38] + + + Kaplan et al., 2007 [40] + + + Pla et al., 2007 [30] + + + Rautiainen et al., 2007 [28] + + + Delgado et al., 2005 [42] + + + Bambha et al., 2003 [39] + + + Hurlburt et al., 2002 [37] + + + Kim et al., 2000 [36] + + + James et al., 1999 [25] + + + Boberg et al., 1998 [27] + + + Metcalf et al., 1997 [26] + + + Danielsson et al., 1990 [18] + + + Myszor et al., 1990 [22] + + + Hamlyn et al., 1983 [16] + + + Lindkvist et al., 2010 [34] + ± + Sood et al., 2004 [46] + ± + Berdal et al., 1998 [24] + ± + Remmel et al., 1995 [23] + ± + Watson et al., 1995 [45] + ± + Löfgren et al., 1985 [20] + ± + Triger et al., 1980 [17] + ± + Kingham et al., 2004 [33] + ? + Byron et al., 1996 [35] + - + Eriksson et al., 1984 [19] + ? "
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    ABSTRACT: Studies on the epidemiology of primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC) show variable outcome. We aimed at systematically reviewing the incidence and prevalence rates, as well as geographical distribution and temporal trends of PSC and PBC. A systematic search of literature was performed in Medline and EMBASE (search last conducted January 10th, 2011). Population-based epidemiological studies reporting incidence and/or prevalence rates for PSC or PBC in a defined geographical area of at least 100,000 adult inhabitants were considered relevant. Study area, study period, number of patients, number of inhabitants, incidence per 100,000 inhabitants per year, prevalence per 100,000 inhabitants, method of case-finding, method of case-ascertainment, male/female ratio and in case of PSC, occurrence of inflammatory bowel diseases (IBD) were extracted from retrieved articles. The literature search yielded 2286 abstracts of which 31 articles fulfilled all inclusion criteria. Studies varied in size from 10 to 770 patients in catchment areas from 100,312 to 19,230,000 inhabitants. The incidence and prevalence rates for PSC range from 0 to 1.3 per 100,000 inhabitants/year and 0-16.2 per 100,000 inhabitants, respectively. PBC incidence rates range from 0.33 to 5.8 per 100,000 inhabitants/year and prevalence rates range from 1.91 to 40.2 per 100,000 inhabitants; prevalence rates are increasing in time. Incidence and prevalence rates of both PSC and PBC vary widely and seem to be increasing. True population-based studies are scarce and therefore large population-based studies combining meticulous case-finding and case-ascertainment strategies are necessary.
    Preview · Article · Jan 2012 · Journal of Hepatology
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    • "Four individuals were diagnosed as PBC, 3 females and 1 male, among 8,126 adults (over age 18) resident in the Southern Chinese city of Guangzhou who attended for an annual health check-up; the rate of hepatitis B virus in this population was 8.1%. The point prevalence rate of PBC was 492 cases per million (95% CI: 128 to 1,093), among the highest reported in other geographical regions [5,22-26]. By considering the risk of PBC for women over 40 years, i.e. a "high risk group", a prevalence of 1,558 cases per million (95% CI: 294 to 3,815) was observed. "
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    ABSTRACT: Primary biliary cirrhosis (PBC) is an autoimmune liver disease characterized by the presence of anti-mitocondrial autoantibodies (AMA) which has an essential role also for diagnosis. In addition, also some anti-nuclear antibodies (ANA) have been shown to be highly specific PBC. The purpose of this study was to assess the prevalence of PBC among the adults referring hospital for annual health check-up in Southern China by screening sera for PBC-specific autoantibodies. AMA and ANA were screened in 8,126 adults (mean age 44 ± 15 years, 48% females) by indirect immunofluorenscence (IIF). Positive sera were tested by ELISA/immunoblotting for AMA-M2, anti-sp100 and anti-gp210. A diagnosis of PBC was re-assessed six months after the initial testing. Out of 8,126 individuals 35 were positive for AMA and 79 positive for ANA. Nineteen, 4, and 3 of the subjects positive for AMA and/or ANA showed reactivity for AMA-M2, anti-sp100 or gp210, respectively, further tested with ELISA/immunoblotting. Fourteen in the 39 individuals positive for AMA at IIF, AMA-M2, anti-gp210, or anti-sp100 had abnormal cholestatic liver functional indices. One definite and 3 probable PBC diagnosis could be made in 4 cases including 3 females and 1 male after half a year. We found a point prevalence rate of PBC among Southern Chinese adults attending for yearly health check-up of 492 cases per million (95% CI, 128 to 1,093) and 1,558 cases per million (95% CI, 294 to 3,815) for women over 40, a finding similar to prevalence reported in other geographical areas.
    Full-text · Article · Sep 2010 · BMC Gastroenterology
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