Cholestasis in active chronic hepatitis

Of 30 patients with active chronic hepatitis studied prospectively over the past 3 years, 14 showed one or more of the following features: prolonged jaundice, pruritus, hypercholesterolemia and elevation of the serum alkaline phosphatase. Six patients had conspicuous clinical and biochemical evidence of cholestasis. Wedge biopsies of the liver were obtained in 3 of these 6 patients, and multiple biopsies in 4 of them, but none of the histologic features characteristic of primary biliary cirrhosis were seen at the time of diagnosis. Antimitochondrial antibodies were absent on repeated testing, except in 1 patient in whom the test became strongly positive 2 years after diagnosis. Repeat biopsy in this patient showed apparent diminution in the number of small bile ducts. In addition, electron microscopic examination of liver biopsies from 2 patients with active chronic hepatitis, without overt evidence of cholestasis, showed ultrastructural evidence of this complication. This study illustrates the overlap which exists between active chronic hepatitis and primary biliary cirrhosis