Retrieval and treatment of patients with primary biliary cholangitis who are lost in the health system.

Autor:	Olveira-Martín A; Gastroenterology, Hospital Universitario La Paz, España., Yebra-Carmona J; Gastroenterology, Hospital Universitario La Paz., Amaral-González C; Gastroenterology, Hospital Universitario de Canarias., Tejedor M; Gastroenterology, Hospital Unuiversitario Infanta Elena, España., Eirás P; Gastroenterology, Complejo Hospitalario Universitario de Santiago., Hernández-Pérez M; Gastroenterology, Hospital Universitario La Paz, España., Suárez-Cabredo C; Gastroenterology, Hospital Universitario La Paz, España., Spigarelli-de Rábago I; Gastroenterology, Hospital Universitario La Paz., Suárez-Ferrer C; Gastroenterology, Hospital Universitario La Paz, ESPAÑA., Morales-Arráez D; Gastroenterology, Hospital Universitario de Canarias, España., Chico I; Gastroenterology, Hospital Universitario Infanta Elena, España., Díaz-Flores F; Laboratory Central, Hospital Universitario de Canarias, España., Rodríguez R; Gastroenterology, Hospital Universitario Infanta Elena, España., Llorente S; Unidad de Investigación (UCICEC), Hospital Universitario La Paz, España., Molina-Pérez E; Gastroenterology, Complejo Hospitalario Universitario de Santiago., Hernández-Guerra de Aguilar MN; Gastroenterology, Hospital Universitario de Canarias.
Jazyk:	angličtina
Zdroj:	Revista espanola de enfermedades digestivas [Rev Esp Enferm Dig] 2021 Nov; Vol. 113 (11), pp. 776-779.
DOI:	10.17235/reed.2021.8174/2021
Abstrakt:	Introduction: hepatitis C patients loss to follow-up in the health care system has been shown to have negative consequences. This study aimed to investigate this issue as regards primary biliary cholangitis. Methods: the databases (immunology, biochemistry, clinical reports, drug dispensation, appointments) of 4 reference hospitals in Spain (serving a population of 1,450,000 inhabitants) were analyzed. The diagnosis of primary biliary cholangitis was based on an antimitochondrial antibody titer ≥ 1:80, chronically elevated alkaline phosphatase, and the absence of other liver disease. Patients were classified as lost in the absence of reports indicating a diagnosis, specific medical follow-up, and/or treatment with bile salts. Results: a total of 1372 patients with antimitochondrial antibody titers ≥ 1:80 were included between January 2010 and June 2019. A total of 697 (50.8 %) were classified as having primary biliary cholangitis, and 100 patients (14.3 %; 95 % CI: 11.8-17.2) were identified as lost. Of these, 30 were contacted and retrieved. The median age was 70 years, 93 % were female, median alkaline phosphatase was 185 IU/L, 10 % had pruritus, and 27 % had a transient elastography value > 9.5 kPa. The disease was confirmed and ursodeoxycholic acid was started in all 30 patients. Death was liver-related in 6 of the 100 patients classified as lost. Conclusion: up to 14.3 % of patients (1 out of 7) with a definitive diagnosis of primary biliary cholangitis remain undiagnosed, thus preventing monitoring and treatment. More than a quarter are at risk of advanced liver disease and its complications. Patients lost in the system must be identified and retrieved, and searching hospital databases is a suitable approach to meet this goal.
Databáze:	MEDLINE
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