Presymptomatic primary biliary cirrhosis.

Clinical, laboratory and follow-up results in 13 patients with primary biliary cirrhosis (PBC) collected during the last 10 years in a well defined population of 250,000 inhabitants are presented. The mean observation time was 5.5 years. 77 percent of these patients have been asymptomatic for many years. Characteristic laboratory features in asymptomatic patients are high alkaline phosphatases and glutamyl transpeptidases and very high levels of polyclonal IgM. ESR is often increased. Signs of active cell destruction are slight and functioning cell mass is well preserved. High titers of mitochondrial antibodies are consistently present. Needle biopsy is seldom sufficient for diagnosis but permits staging of the disease. There is no correlation between clinical features and histological evolution stage. Compared with a preceding 10-year period, the incidence of PBC has risen threefold. This increase can be fully explained by the extended use of laboratory facilities, resulting in the detection of asymptomatic patients.