I am a 42 yr old male. Have hx of mildly elevated ALT. (around 60). Last year physician ordered several test. Hep panel all negative. Liver ultrasound which showed mild case of fatty liver. I have gained some weight over the last couple of years. I am not a heavy drinker.
Just had physical recently. AST was 46. ALT 58. Normal bilirubin. Normal Alkaline Phos. Smooth muscle AB normal. However, physician ordered AMA M2 AB test. Came back positive with value of 30. I have no symptoms and otherwise healthy male. Controlled hypertension.
Do you think I have PBC? False positive? Should get liver biopsy? Monitor?
I would greatly appreciate any insight you can provide.
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jonathan23
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Your numbers sound similar to where mine were a few years ago except I did not have normal Alk phos. This all started after I had my gallbladder removed. My doctor just continued to monitor me every 6 months and they slowly crept up. My understanding is (but ask your doctor please), is you can have positive M2 and never have issues. Hopefully you will be one of those people. My doc recommended biopsy and still does, but I refuse as I don't feel it is going to help me in any way, but rather annoy my liver some more. That is your decision. Did he recommend urso yet? Just curious. Also, I found a great page with Questions and answers from doctors that may be of great interest to you and anyone else on here.
Thank you for the link! I read it ages ago but forgot to bookmark it and couldn't find it again. It was the 3rd question in particular that interested me and the reply has been needed for so many posts on this site.
Another good question and answer site by doctors can be found on the Canadian PBC site:
You're welcome badpiglet. And yes, that 3rd question and answer if very important.
"The best biochemical tests of liver "function" are serum albumin concentration, serum bilirubin concentration and prothrombin time. In PBC, the serum bilirubin concentration (which may also be lowered by ursodiol) is probably the best biochemical predictor of disease progression."
what does your dr. say about your test results. ama is not diagnostic test to confirm 100 % pbc but it will help to rule out other liver problems. when i was diagnosed my liver enzyme were almost double the normal range and ama , ana, igg, igm all were high and positive and they thought i have both autoimmune hep and pbc.. they told me to do stat biopsy which i did but came out normal so they rule out everything but the pbc. now i have hypothyroid too. my suggestion to you is be patient and have another opinion from good experienced specialist and tell them to check your thyroid panel too.. thyroid can messed up lots of hormones, enzymes and etc.
Your situation is consistent with, but not diagnostic of, PBC. It sounds similar to where I started as well (41 year old male), except that I didn't have AST elevation. The ALT elevation resolved when I changed the vitamins/supplements I was taking.
As I've documented in other posts, AMA is far more prevalent than PBC, especially in males. So in my view, you likely do *not* have PBC, although we certainly can't rule it out. I recommend getting blood levels checked every six months, and proceeding to biopsy/starting Urso only if ALP becomes elevated. Also, see whether losing weight and changing diet/meds/supplements can resolve your ALT and AST elevations.
THX for responses. Kevin out of curiousity what was your AMA M2? Sounds like without an elevated ALP cannot make diagnosis alone. Definitely going to work on weight loss and getting back into shape.
I'm in a similar boat have an +AMA-M2 of 69 and an enlarged fatty liver diagnosed by biopsy, however no evidence of inflammation or damage consistent with PBC. I'm now getting enzymes checked every 6 months. My primary Dr. believes I'll probably be getting another biopsy in the future, so not completely out of the woods yet and a negative biopsy could be due to sampling error as was stated on my pathology report. I would think your Dr. might wait and recheck your AMA and enzymes and go from there. I have a book "Dr. Melissa Palmer's guide to Hepatitis & Liver Disease" ..revised edition. It came highly recommended by a member of another liver forum that I was on and the author is on the medical advisory board of the American Liver Foundation and is an internationally renowned Hepatologist. Anyway, the book says anything lower than 1:40 sometimes disappears on repeat bloodwork. I would have it rechecked again along with your enzymes. There is a member on this forum sorry can't remember her username that has stated that her Lfts have always been normal and she has PBC stage 3 (I believe) through biopsy. There are those with significant liver disease and normal enzymes. Another member ranrace was diagnosed with NASH and PBC and his started with an elevated ALT from what I recall, but was confirmed by biopsy, so not everybody will be textbook. Though he stated that his ALP was in the low 100's, so probably high normal. Also, I've read it could be so early in the disease process that it just isn't going to show up on biopsy until a later date. Some members have had 3 samples taken at once during a biopsy whereas most seem to have only one taken. I can only surmise that was to reduce sampling errors, but is probably more risky. Do you have any other autoimmune diseases? My book states that 84% of those with PBC have other autoimmune diseases. I think your Dr. will look at the totality of your case and go from there, but since you have an AMA under 40 with no symptoms that can only be good. As a side note, the book states don't lose weight too quickly with fatty liver it could make things worse you should aim for 1-2 pds of weight loss per week. I also found this link and it's from the hospital that I had my biopsy done at (SLU in St Louis Mo.) with some very good patient questions and answers from Drs. friendsoftheslulc.org/infor... Sorry if I ramble on, my thoughts are all over the place. Hope this was helpful. Good luck to you!
Hi, If I am AMA M2 pozitive is PBC for sure? The liver is fine, I had fibromax test. For so many years my body hurts and I have a daily diarrhea and, sometimes, a pain under the right coast. I tried to find out what kind of desease could be and started to have some tests and I was found pozitive for AMA M2? Could it be other desease? Like Addison or smth else? I will have an IRM within 2 months.
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