Study on cryptogenic chronic liver disease having elevated alkaline phosphatase levels with special reference to primary biliary cirrhosis and anti mitochondrial antibody (ama) in indian population -- A case –Control study

Background: The anti-mitochondrial antibody (AMA) is frequently tested in cryptogenic cirrhosis (CC) with elevated alkaline phophatase (ALP) levels. Like other group of chronic liver disease of known etiology may , on the course of time, lead to decompantion , liver failure and Hepatocellular carcinoma, Cryptogenic liver disease has similar course which need to be evaluated early. Aims: To determine how frequently AMA test is positive in the above mentioned clinical situation and to identify the discriminating value of clinical features in patient who tested positive in both study groups. Setting and design: Tertiary care hospital based retro-spective case control study. Materials and Methods: This was a retrospective study where 120 patients with chronic liver disease for whom the anti mitochondrial test (AMA) was done because of a raised alkaline phosphatase (ALP) formed the population from which cases and controls were drawn. 10 patients who tested AMA positive served as cases and 20 subjects that were randomly chosen from the AMA negative group served as controls. Results: AMA was rarely positive (about 8.33%) in this group of cryptogenic chronic liver disease with high ALP values in Indian. The only discriminating investigations are a high Total Bilirubin, and activated Partial Thromboplastin Time in cases which are AMA positive. The liver biopsy of one patient having AMA negative found to have features of Primary biliary Cirrhosis in our study. Conclusion: We need to do liver biopsy in the early part of the disease to ascertain the pathogenetic mechanism of liver injury in the crypto group, because in the advanced stage we hardly find the accurate sample for histopathologic evaluation. This is not an argument for discarding the AMA test in Indians but it may throw light on the evolution of this disease.