Cholestatic Presentation of Chronic Hepatitis C:

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Digestive Diseases and Sciences

46 (10):2066-2073, October 2001.

© Plenum Publishing Corporation

Cholestatic Presentation of Chronic Hepatitis C: A

Clinical and Histological Study with a Review of the

Literature

K. Shiva Kumar

Division of Digestive & Liver Diseases, Department of

Internal Medicine, University of Texas Southwestern

Medical Center, 5323 Harry Hines Boulevard, Dallas,

Texas 75390, USA

M.H. Saboorian

Department of Pathology, University of Texas

Southwestern Medical Center, 5323 Harry Hines

Boulevard, Dallas, Texas 75390, USA

M. Lee

Division of Digestive & Liver Diseases, Department of

Internal Medicine, University of Texas Southwestern

Medical Center, 5323 Harry Hines Boulevard, Dallas,

Texas 75390, USA

Abstract

Bile duct lesions are observed in the livers of

chronic hepatitis C patients, but are inconstant and

rarely associated with other features of chronic

cholestasis and progressive bile duct injury or loss.

We aimed to identify the clinical and biochemical

characteristics of patients with chronic hepatitis C

from our patient database presenting with prominent

cholestatic features to determine if there is a

correlation between histological evidence of bile duct

injury and clinical or biochemical features observed

in these patients. We retrospectively reviewed a

hepatitis C database including 620 patients to

identify those who presented with either alkaline

phosphatase (AP) ³ 400 units/liter (normal 30–126

units/liter) or AP ³ 250 units/liter with pruritus.

All patients were negative for anti-mitochondrial

antibody (AMA). Appropriate exclusion criteria were

used to exclude patients with other confounding

factors. Histological features were compared with age-

and sex-matched controls selected randomly from our

hepatitis C database. Thirty-two patients were

identified as meeting the above criteria. Twenty-four

were excluded for the presence of other confounding

factors and two for lack of liver biopsy. There were

two men and four women. The mean age was 47 ± 9 years.

Four of the six presented with pruritus, which was

severe in three. Liver biopsy showed evidence of

moderate to severe fibrosis in all but one patient.

Evidence of bile duct injury was seen in all patients

and tended to be more severe than in controls. Bile

ductular proliferation and mild ductopenia were the

most commonly observed findings. A subset of patients

with chronic hepatitis C may present with prominent

cholestatic features. The majority of these patients

present with pruritus and have histological evidence

of bile duct injury, which may be progressive.

Keywords

chronic hepatitis C, bile ducts, cholestasis

ISSN 0163-2116

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