A190 POST-PARTUM PRIMARY BILIARY CHOLANGITIS (PBC) AFTER RESOLUTION OF INTRAHEPATIC CHOLESTASIS OF PREGNANCY (ICP) IN FIRST NATION’S PATIENTS OF BC: A CASE SERIES
Bibliographic record
Abstract
Abstract Background PBC is a progressive cholestatic disease characterized by destruction of intrahepatic bile ducts, peri-portal inflammation and fibrosis. PBC is the leading indication for liver transplantation in First Nations of British Columbia. Diagnosis of PBC during pregnancy is difficult due to clinical overlap with ICP and pregnancy induced immune tolerance (4–6). We present 3 cases of clinically diagnosed ICP in First Nations women who were later diagnosed with PBC post-partum. Aims To investigate the potential relationship between ICP and PBC in the First Nations community of BC. Methods Retrospective review of relevant cases. Results Case 1: A 27-year-old woman with history of ICP at 31 weeks during her 3rd pregnancy and family history of PBC presented with ursodiol and cholestyramine responsive pruritis and jaundice 20 weeks into her 4th pregnancy. Bilirubin was 103 µmol/L, ALP 371 IU/L, ANA and AMA negative. Symptoms and biochemistry remained in remission after delivery at 33 weeks. Discontinuation of medications led to recurrent pruritis 4 months later. Bilirubin was 6 µmol/L, ALP 272 IU/L, GGT 153 IU/L and ALT 204 IU/L. Liver biopsy was consistent with PBC, F1. Pruritis has now been refractory to ursodiol, cholestyramine and rifampin. Case 2: A 30-year-old woman with history of ICP at 20 weeks during 2 prior pregnancies presented with ursodiol responsive pruritis 20 weeks into her 3rd pregnancy. Symptoms and biochemistry remained in remission after delivery at 35 weeks. Post-partum discontinuation of ursodiol led to recurrent pruritis 2 months later. ALP was 876 and AMA >1:640. Re-initiation of ursodiol improved symptoms and biochemical abnormalities. Case 3: A 30-year-old woman with family history of PBC (mother) presented with ursodiol responsive pruritis and jaundice 20 weeks into her 4th pregnancy. Symptoms and biochemistry remained in remission after delivery at 37 weeks. Post-partum discontinuation of ursodiol led to recurrence jaundice 4 months later. Bilirubin was 68, ALP 1279, total cholesterol 7.72, IgM 18.98, ANA >1:640 and AMA 1:320. Jaundice and biochemical abnormalities persisted despite re-initiation of ursodiol. Obeticholic acid has been initiated. Conclusions First Nations communities of BC are disproportionately affected by PBC, due to both genetic and epigenetic phenomena. We present 3 patients who were diagnosed with ICP that resolved post-partum but with the subsequent development of PBC. The intrapartum cholestasis did not have clinical features of PBC during pregnancy. Although not previously reported, ICP may predispose to PBC in this specific community. It remains to be seen if there is a genetic association. Clinicians must remain suspicious of PBC during pregnancy in this population and ongoing monitoring in the post-partum period is paramount. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".