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Clinical significance of the Scheuer histological staging system for primary biliary cholangitis in Japanese patients

Namisaki, Tadashi; Moriya, Kei; Kitade, Mitsuteru; Kawaratani, Hideto; Takeda, Kosuke; Okura, Yasushi; Takaya, Hiroaki; Nishimura, Norihisa; Seki, Kenichiro; Kaji, Kosuke; Sato, Shinya; Sawada, Yasuhiko; Yamao, Junichi; Mitoro, Akira; Uejima, Masakazu; Mashitani, Tsuyoshi; Shimozato, Naotaka; Nakanishi, Keisuke; Furukawa, Masanori; Saikawa, Soichiro; Kubo, Takuya; Yoshiji, Hitoshi

European Journal of Gastroenterology & Hepatology: January 2017 - Volume 29 - Issue 1 - p 23–30
doi: 10.1097/MEG.0000000000000765
Original Articles: Hepatitis

Background Inadequate response to ursodeoxycholic acid (UDCA) is associated with unfavorable outcomes in patients with primary biliary cholangitis (PBC). We aimed to identify surrogate markers for predicting long-term prognosis and biochemical response to UDCA in patients with PBC.

Patients and methods In this single-center, retrospective study, 99 patients with PBC were classified into responders (n=53) and nonresponders (n=46) based on reductions in the γ-glutamyl transpeptidase levels at 1 year after initiating UDCA therapy (Nara criteria). We assessed whether the criteria for patentability by different countries are useful in predicting the prognosis of PBC. The accuracy of Scheuer and Nakanuma staging systems in predicting prognosis and treatment response was compared.

Results Nara definition had comparable utility to the Paris-II definition for selecting patients in whom UDCA monotherapy can be safely continued. Patients at Scheuer stage 1 had a significantly better prognosis than those at Scheuer stages 3 or 4 (P<0.05 and 0.0001, respectively). Patients at Nakanuma stage 4 had decreased survival compared with those at stage 1 (P<0.05). The proportion of responders to nonresponders was significantly higher in stages 1–3 PBC than in stage 4 PBC, according to both staging systems (P<0.05 for both). All patients with Scheuer stage 4 PBC were nonresponders, whereas only 28.6% (2/7) of those with Nakanuma stage 4 PBC were responders.

Conclusion The Scheuer staging system had greater utility in predicting long-term prognosis and UDCA response than the Nakanuma staging system.

aThird Department of Internal Medicine, Nara Medical University

bDepartment of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan

Correspondence to Tadashi Namisaki, MD, Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan Tel: +81 744 22 3015; fax: +81 744 24 7122; e-mail:

Received June 2, 2016

Accepted September 2, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.