Scientific letter
Chronic cholestasis in a 20-year-old young man: A case of idiopathic adulthood ductopenia
Colestasis crónica en un joven de 20 años: un caso de la vida adulta ductopenia idiopática
Read
6309
Timeswas read the article
1156
Total PDF
5153
Total HTML
Share statistics
array:23 [ "pii" => "S0210570513001994" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2013.07.003" "estado" => "S300" "fechaPublicacion" => "2013-12-01" "aid" => "658" "copyright" => "Elsevier España, S.L. and AEEH y AEG" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Gastroenterol Hepatol. 2013;36:628-30" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1949 "formatos" => array:3 [ "EPUB" => 15 "HTML" => 1404 "PDF" => 530 ] ] "itemSiguiente" => array:18 [ "pii" => "S0210570513000691" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2013.01.006" "estado" => "S300" "fechaPublicacion" => "2013-12-01" "aid" => "603" "copyright" => "Elsevier España, S.L. and AEEH y AEG" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Gastroenterol Hepatol. 2013;36:631-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 25936 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 23666 "PDF" => 2258 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Progresos en gastroenterología</span>" "titulo" => "Fluidoterapia en la pancreatitis aguda" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "631" "paginaFinal" => "640" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Fluid therapy in acute pancreatitis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 824 "Ancho" => 1588 "Tamanyo" => 114621 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Modelo dinámico entre fluidoterapia y pronóstico en la pancreatitis aguda.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">De De Madaria et al. Clin Gastroenterol Hepatol. 2012<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Enrique de-Madaria" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Enrique" "apellidos" => "de-Madaria" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570513000691?idApp=UINPBA00004N" "url" => "/02105705/0000003600000010/v1_201312060056/S0210570513000691/v1_201312060056/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0210570513001854" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2013.06.002" "estado" => "S300" "fechaPublicacion" => "2013-12-01" "aid" => "647" "copyright" => "Elsevier España, S.L. y AEEH y AEG" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Gastroenterol Hepatol. 2013;36:626-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1470 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 1196 "PDF" => 265 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Utilidad de la cápsula endoscópica urgente en hemorragia digestiva grave secundaria a hemangiomatosis intestinal difusa" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "626" "paginaFinal" => "628" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Usefulness of urgent endoscopic capsule in severe gastrointestinal bleeding due to diffuse intestinal hemangiomatosis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 453 "Ancho" => 1000 "Tamanyo" => 99537 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A y B) Imagen de cápsula endoscópica y enteroscopia posterior donde se identifican múltiples lesiones azuladas a lo largo del intestino delgado, a partir de yeyuno presentando sangrado activo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Concepción García Sánchez, Maite Maroto Castellanos, Laura Crespo Pérez, Carla Senosiain Lalastra, Ángel Cañete Ruiz, Víctor Moreira Vicente, Javier Graus Morales, Daniel Boixeda de Miquel, Agustín Albillos Martínez" "autores" => array:9 [ 0 => array:2 [ "nombre" => "M. Concepción" "apellidos" => "García Sánchez" ] 1 => array:2 [ "nombre" => "Maite" "apellidos" => "Maroto Castellanos" ] 2 => array:2 [ "nombre" => "Laura" "apellidos" => "Crespo Pérez" ] 3 => array:2 [ "nombre" => "Carla" "apellidos" => "Senosiain Lalastra" ] 4 => array:2 [ "nombre" => "Ángel" "apellidos" => "Cañete Ruiz" ] 5 => array:2 [ "nombre" => "Víctor" "apellidos" => "Moreira Vicente" ] 6 => array:2 [ "nombre" => "Javier" "apellidos" => "Graus Morales" ] 7 => array:2 [ "nombre" => "Daniel" "apellidos" => "Boixeda de Miquel" ] 8 => array:2 [ "nombre" => "Agustín" "apellidos" => "Albillos Martínez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570513001854?idApp=UINPBA00004N" "url" => "/02105705/0000003600000010/v1_201312060056/S0210570513001854/v1_201312060056/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Chronic cholestasis in a 20-year-old young man: A case of idiopathic adulthood ductopenia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "628" "paginaFinal" => "630" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pilar Peniche-Moquel, José Luis Pérez-Hernández, Jacqueline Cordova" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Pilar" "apellidos" => "Peniche-Moquel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "José Luis" "apellidos" => "Pérez-Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "Jacqueline" "apellidos" => "Cordova" "email" => array:2 [ 0 => "jacquiemex2@yahoo.com.mx" 1 => "jacquiemexfr@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unit of Gastroenterology, Mexico's General Hospital “Dr. Eduardo Liceaga”, O.D., Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Division of Transplantation, Mexico's General Hospital “Dr. Eduardo Liceaga”, O.D., Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colestasis crónica en un joven de 20 años: un caso de la vida adulta ductopenia idiopática" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1185 "Ancho" => 1447 "Tamanyo" => 324737 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasonographic and CPMRI examinations. (A) Liver ultrasound: unchanged liver morphology. (B) CPMRI showing anormal bile ducts. (C, D) Histologic findings on liver biopsy specimen with Hematoxylin–eosin and PAS staining respectively demonstrate that branches of the hepatic artery (white arrow) and portal vein (black arrow) are present in the portal tract, but interlobular bile ducts are absent. There is a mild lymphocytic inflammatory infiltrate (thick arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Idiopathic adulthood ductopenia (IAD) is a rare disease whose etiology is not known. It is a chronic cholestatic liver condition which appears at an adult age; in which there is loss of bile ducts in more than 50% of portal tracts.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Several conditions are associated with a decrease in the number of intrahepatic bile ducts of small and medium size. Some result in development failure and others are disorders that lead to acquired ductopenia, some of which are associated with destruction of the bile duct epithelium and for others there is no apparent inflammatory process.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A male, 20 years old, previously healthy, with no history of jaundice at birth or in childhood, denies alcoholism, smoking or other addictions, no previous use of drugs or herbal products, was referred to the Mexico's General Hospital with symptoms of 6 months of evolution characterized by fatigue, weakness, itching, routine laboratory tests were performed finding persistent cholestasis. Physical examination was normal, with no stigmata of chronic liver disease. The laboratory tests showed Total Bilirubin (BT) 0.8<span class="elsevierStyleHsp" style=""></span>mg/dL (0.3–0.9<span class="elsevierStyleHsp" style=""></span>mg/dL), alkaline phosphatase (ALP) 618<span class="elsevierStyleHsp" style=""></span>U/l (44–147<span class="elsevierStyleHsp" style=""></span>U/L), Gamma glutamyltranspeptidase (GGT) 912<span class="elsevierStyleHsp" style=""></span>U/l (40–78<span class="elsevierStyleHsp" style=""></span>U/L), aspartate aminotransferase (AST) 213<span class="elsevierStyleHsp" style=""></span>U/L (8–40<span class="elsevierStyleHsp" style=""></span>U/L), alanine aminotransferase (ALT) 433<span class="elsevierStyleHsp" style=""></span>U/L (7–33<span class="elsevierStyleHsp" style=""></span>U/L). Viral Hepatitis Panel for B, <span class="elsevierStyleSmallCaps">C</span> and HIV were performed and were negative. Serologic tests for anti-nuclear, anti-mitochondrial, anti-smooth muscle, anti-LKM1 antibodies were negative. The ceruloplasmin and copper in 24-h urine were normal. An abdominal ultrasound performed showed no abnormalities in liver morphology, portal vein and hepatic permeable, unaltered hepatic artery, without dilatation of the intrahepatic or extrahepatic bile ducts. The CPMRI was unaltered. Percutaneous liver biopsy was performed reporting: preserved liver architecture, sparse chronic inflammatory infiltrate, bile duct not observed in over 50% of portal tracts observed (see <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was diagnosed with idiopathic adult ductopenia, treatment was started with a dose of ursodeoxycholic acid (13–15<span class="elsevierStyleHsp" style=""></span>mg/kg/day) 250<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h, mild improvement in symptoms and liver function tests was observed after 6 months of treatment (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Ductopenia describes the loss of septal and interlobular bile ducts for any reason with the possibility of the development of biliary cirrhosis or hepatic insufficiency.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However, there have been several clinical cases of non-progressive IAD.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most common causes of chronic cholestasis are primary biliary cirrhosis diseases (PBC) and primary sclerosing cholangitis (PSC), in 90% of cases, representing the IAD in only 1% of cases.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> In IAD there may be evidence of ductopenia in the biopsy, but there are no clinical, biochemical or serological findings indicating a specific cause.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It affects young adults, with a male predominance<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with an average year of appearance at 30 for men and 26 for women.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> The current diagnostic criteria include biochemical cholestasis and histopathological evidence of ductopenia in the absence of primary sclerosing cholangitis or inflammatory bowel disease.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,8</span></a> The diagnosis must be made on the loss of septal or interlobular bile ducts in at least 50% of portal tracts, to be considered significant, at least 20 or more portal tracts, and the absence of granulomatous cholangitis or a florid duct lesion.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,9</span></a> The clinical course is variable, some patients may be asymptomatic, other patients may have episodes of jaundice and itching and with elevated serum liver enzymes. Two types of IAD have been recognized, each with different prognosis, the patients who develop type 1 are asymptomatic or manifest symptoms of chronic cholestatic disease, tend to have less destruction of bile ducts in liver biopsy specimens. In contrast with type 2 where patients can have initial symptoms of decompensated biliary cirrhosis, extensive destruction of intrahepatic bile ducts can be found, and liver biopsy is often required.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In a review of 25 patients with the diagnosis of IAD, it was found that bilirubin levels could be up to 26<span class="elsevierStyleHsp" style=""></span>mg/dL, the ALP and GGT values ranged from 3 to 16 and 14 times the normal upper limit respectively, and the levels of aminotransferases could vary from normal to an elevation of 10 times the upper limit.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,10</span></a> In about half the cases reported the IAD appears to have a benign course, while the rest of the IAD were mortal or merited liver transplantation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although the cause has not been determined, several hypotheses have been made, such as, that the destruction of the bile ducts is caused by an unknown virus or a toxic metabolite. Host factors may contribute to susceptibility to developing the disease, in a study by Garcia-Jimenez et al. with genes HLA-DR, no significant association between HLA-DRB1 alleles and disease was found, but suggests that IAD may have immunogenetic basis in its development.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The degree of ductopenia is variable, when it is mild, it may be overlooked during histopathology.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The IAD is a rare disease, with unknown pathogenesis and evolution. The uncertainties about the etiology preclude a specific treatment; in a non-aggressive disease (type 1 IAD) ursodeoxycholic acid (UDCA) can be used for treatment. A beneficial effect has been suggested but it is unknown its effect on disease progression.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6</span></a> Sometimes only liver transplantation offers a cure, especially in cases where cholestatic symptoms are intractable like the severe itching or when there are symptoms of liver failure.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, it would be important to perform a research to identify possible causes and pathogenesis of the disease, to predict the likely clinical course, and to offer appropriate treatment according to the presentation of the IAD.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:2 [ "identificador" => "xack69435" "titulo" => "Acknowledgment" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1185 "Ancho" => 1447 "Tamanyo" => 324737 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasonographic and CPMRI examinations. (A) Liver ultrasound: unchanged liver morphology. (B) CPMRI showing anormal bile ducts. (C, D) Histologic findings on liver biopsy specimen with Hematoxylin–eosin and PAS staining respectively demonstrate that branches of the hepatic artery (white arrow) and portal vein (black arrow) are present in the portal tract, but interlobular bile ducts are absent. There is a mild lymphocytic inflammatory infiltrate (thick arrow).</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">TBIL, total bilirubin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, gamma glutamyl transpeptidase.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">LFT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Beginning of treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">12 months \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TBIL (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALT (UI/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">433 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">420 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">380 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">312 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">300 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AST (UI/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">213 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">210 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">190 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">189 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">189 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALP (UI/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">618 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">630 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">600 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">558 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">500 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GGT (UI/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">912 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">950 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">920 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">870 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">820 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab432916.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evolution of Liver function test profiles (LFT), at the beginning of treatment and during follow-up at 3, 6 and 12 months.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic biliary ductopenia in adults without symptoms of liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Moreno" 1 => "V. Carreño" 2 => "A. Cano" 3 => "C. González" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199703203361204" "Revista" => array:6 [ "tituloSerie" => "NEJM" "fecha" => "1997" "volumen" => "336" "paginaInicial" => "835" "paginaFinal" => "838" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9062092" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary biliary cirrhosis and other ductopenic diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.B. Alastair" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Liver Dis" "fecha" => "2002" "volumen" => "6" "paginaInicial" => "363" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12122861" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The variant forms of cholestatic diseases involving small bile ducts in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "O. Chazouillères" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hepatol" "fecha" => "2000" "volumen" => "32" "paginaInicial" => "16" "paginaFinal" => "18" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic adulthood ductopenia: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Ludwing" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0025-6196(11)64473-X" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "1998" "volumen" => "73" "paginaInicial" => "285" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9511789" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic adulthood ductopenia: a cause of chronic cholestatic liver disease and biliary cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Ludwing" 1 => "R.H. Wiesner" 2 => "N.F. LaRusso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "1988" "volumen" => "7" "paginaInicial" => "193" "paginaFinal" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3057064" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of idiopathic adulthood ductopenia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.C. Park" 1 => "S.M. Park" 2 => "E.Y. Choi" 3 => "H.B. Chae" 4 => "S.J. Yoon" 5 => "R. Sung" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Korean J Intern Med" "fecha" => "2009" "volumen" => "24" "paginaInicial" => "271" "paginaFinal" => "272" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variant forms of cholestatic diseases involving small bile ducts in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W.R. Kim" 1 => "J. Ludwing" 2 => "K.D. Lindor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2000.01999.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2000" "volumen" => "95" "paginaInicial" => "1130" "paginaFinal" => "1138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10811317" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopahtic adulthood ductopenia: a diagnosis: two clinicopathological courses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Dominguez-Antonaya" 1 => "J.M. Coba-Ceballos" 2 => "M. Gomez-Rubio" 3 => "B. de Cuenca" 4 => "P. Ortega-Muñoz" 5 => "J. García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2000" "paginaInicial" => "210" "paginaFinal" => "212" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of HLA-DR genes with mild idiopathic adulthood biliary ductopenia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.E. García-Jiménez" 1 => "J.A. Quiroga" 2 => "M.L. Gutiérrez" 3 => "M. Pardo" 4 => "V. Carreño" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2001.03717.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2001" "volumen" => "96" "paginaInicial" => "1178" "paginaFinal" => "1182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11318008" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical efficacy and effectiveness of ursodeoxycholic acid in cholestatic liver diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Festi" 1 => "M. Montagnani" 2 => "F. Azzaroli" 3 => "F. Lodato" 4 => "G. Mazzella" 5 => "A. Roda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Clin Pharmacol" "fecha" => "2007" "volumen" => "2" "paginaInicial" => "155" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18690863" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack69435" "titulo" => "Acknowledgment" "texto" => "<p id="par0045" class="elsevierStylePara elsevierViewall">Eduardo Perez Torres, M.D., Chief of Gastroenterology Division and Gerardo Aristi Urista, M.D., Pathology Department.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/02105705/0000003600000010/v1_201312060056/S0210570513001994/v1_201312060056/en/main.assets" "Apartado" => array:4 [ "identificador" => "21464" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Carta científicias" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105705/0000003600000010/v1_201312060056/S0210570513001994/v1_201312060056/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570513001994?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 26 | 7 | 33 |
| 2024 September | 59 | 10 | 69 |
| 2024 August | 41 | 5 | 46 |
| 2024 July | 60 | 5 | 65 |
| 2024 June | 44 | 9 | 53 |
| 2024 May | 40 | 10 | 50 |
| 2024 April | 84 | 7 | 91 |
| 2024 March | 57 | 13 | 70 |
| 2024 February | 79 | 11 | 90 |
| 2024 January | 63 | 4 | 67 |
| 2023 December | 70 | 13 | 83 |
| 2023 November | 81 | 12 | 93 |
| 2023 October | 107 | 4 | 111 |
| 2023 September | 58 | 6 | 64 |
| 2023 August | 79 | 2 | 81 |
| 2023 July | 75 | 10 | 85 |
| 2023 June | 61 | 2 | 63 |
| 2023 May | 86 | 7 | 93 |
| 2023 April | 53 | 6 | 59 |
| 2023 March | 69 | 4 | 73 |
| 2023 February | 64 | 5 | 69 |
| 2023 January | 78 | 21 | 99 |
| 2022 December | 62 | 6 | 68 |
| 2022 November | 91 | 29 | 120 |
| 2022 October | 62 | 14 | 76 |
| 2022 September | 43 | 18 | 61 |
| 2022 August | 52 | 23 | 75 |
| 2022 July | 43 | 13 | 56 |
| 2022 June | 46 | 18 | 64 |
| 2022 May | 66 | 15 | 81 |
| 2022 April | 121 | 14 | 135 |
| 2022 March | 106 | 25 | 131 |
| 2022 February | 90 | 12 | 102 |
| 2022 January | 80 | 26 | 106 |
| 2021 December | 55 | 22 | 77 |
| 2021 November | 55 | 9 | 64 |
| 2021 October | 55 | 21 | 76 |
| 2021 September | 53 | 12 | 65 |
| 2021 August | 61 | 9 | 70 |
| 2021 July | 70 | 11 | 81 |
| 2021 June | 45 | 11 | 56 |
| 2021 May | 71 | 9 | 80 |
| 2021 April | 173 | 19 | 192 |
| 2021 March | 114 | 21 | 135 |
| 2021 February | 107 | 9 | 116 |
| 2021 January | 77 | 11 | 88 |
| 2020 December | 66 | 8 | 74 |
| 2020 November | 66 | 9 | 75 |
| 2020 October | 63 | 10 | 73 |
| 2020 September | 51 | 11 | 62 |
| 2020 August | 56 | 12 | 68 |
| 2020 July | 38 | 3 | 41 |
| 2020 June | 24 | 5 | 29 |
| 2020 May | 40 | 10 | 50 |
| 2020 April | 43 | 3 | 46 |
| 2020 March | 53 | 3 | 56 |
| 2020 February | 47 | 3 | 50 |
| 2020 January | 35 | 3 | 38 |
| 2019 December | 49 | 10 | 59 |
| 2019 November | 33 | 8 | 41 |
| 2019 October | 36 | 8 | 44 |
| 2019 September | 35 | 8 | 43 |
| 2019 August | 15 | 2 | 17 |
| 2019 July | 25 | 18 | 43 |
| 2019 June | 56 | 37 | 93 |
| 2019 May | 167 | 28 | 195 |
| 2019 April | 74 | 40 | 114 |
| 2019 March | 18 | 16 | 34 |
| 2019 February | 17 | 9 | 26 |
| 2019 January | 19 | 2 | 21 |
| 2018 December | 22 | 14 | 36 |
| 2018 November | 32 | 3 | 35 |
| 2018 October | 35 | 3 | 38 |
| 2018 September | 27 | 6 | 33 |
| 2018 August | 3 | 9 | 12 |
| 2018 July | 13 | 4 | 17 |
| 2018 June | 9 | 3 | 12 |
| 2018 May | 10 | 6 | 16 |
| 2018 April | 9 | 5 | 14 |
| 2018 March | 10 | 3 | 13 |
| 2018 February | 7 | 3 | 10 |
| 2018 January | 5 | 4 | 9 |
| 2017 December | 2 | 8 | 10 |
| 2017 November | 13 | 4 | 17 |
| 2017 October | 7 | 4 | 11 |
| 2017 September | 14 | 7 | 21 |
| 2017 August | 18 | 6 | 24 |
| 2017 July | 12 | 6 | 18 |
| 2017 June | 25 | 24 | 49 |
| 2017 May | 32 | 10 | 42 |
| 2017 April | 23 | 7 | 30 |
| 2017 March | 9 | 33 | 42 |
| 2017 February | 26 | 2 | 28 |
| 2017 January | 16 | 2 | 18 |
| 2016 December | 37 | 6 | 43 |
| 2016 November | 34 | 5 | 39 |
| 2016 October | 65 | 4 | 69 |
| 2016 September | 52 | 15 | 67 |
| 2016 August | 34 | 3 | 37 |
| 2016 July | 19 | 2 | 21 |
| 2016 June | 46 | 9 | 55 |
| 2016 May | 19 | 17 | 36 |
| 2016 April | 13 | 10 | 23 |
| 2016 March | 26 | 12 | 38 |
| 2016 February | 15 | 16 | 31 |
| 2016 January | 22 | 11 | 33 |
| 2015 December | 11 | 11 | 22 |
| 2015 November | 0 | 8 | 8 |
| 2015 October | 0 | 8 | 8 |
| 2015 September | 0 | 5 | 5 |
| 2015 August | 0 | 2 | 2 |
| 2015 June | 0 | 1 | 1 |
| 2015 January | 0 | 1 | 1 |
| 2014 October | 1 | 0 | 1 |
| 2014 April | 1 | 0 | 1 |
| 2014 February | 1 | 5 | 6 |
| 2014 January | 13 | 3 | 16 |
| 2013 December | 7 | 10 | 17 |
Show all
