Asian Journal of Research and Reports in Hepatology

Impact of ERCP on Cholestatic Liver Enzymes in Patients with Obstructive Jaundice at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun, Nigeria

2026-02-27T11:13:12+00:00

Background: Obstructive jaundice is a common hepatobiliary disorder characterized by impaired bile flow and cholestasis, leading to significant morbidity if not promptly treated. Gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) are key cholestatic liver enzymes widely used in the diagnosis and monitoring of biliary obstruction.

Aim: The present study evaluates GGT and ALP and activities in elderly patients with obstructive jaundice following ERCP at Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria.

Methods: A total of 100 elderly men and women, aged 60 years and above, diagnosed of extrahepatic biliary obstruction, preparing for ERCP at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria, were recruited for the study. Blood specimen was drawn from the subjects 48 hours before ERCP and one week after ERCP. The blood samples collected were determined for serum GGT and ALP activities using colorimetric methods. Statistical package for the social science, version 26.0 was used to obtain the results in mean ± SD. Paired t test was used to determine difference between means at a significant level of 0.05.

Results: The mean result of ALP activity was 572.3 ± 263.3 IU/L and GGT was 505.9 ± 236.6 IU/L at 48 hours before ECRP. While the result of mean ALP activity was 295.2 ± 158.1 IU/L, and GGT activity was 258.0 ± 124.9 IU/L, after one week of ECRP procedure. The paired t test comparisons of the enzymes activities, before and after ECRP procedure, showed significant decrease in ALP and GGT activities after ERCP procedure (P<0.05).

Conclusion: ERCP resulted in rapid and substantial declines in GGT and ALP activities among the elderly patients with obstructive jaundice. These findings highlight the usefulness of GGT and ALP as reliable biomarkers for assessing the resolution of biliary obstruction and monitoring treatment response.

Endoscopic Biliary Drainage by ERCP in the Management of Malignant Biliopancreatic Strictures: A Six-Year Single-Center Retrospective Study

2026-05-30T11:26:14+00:00

Background: Malignant biliopancreatic strictures are a major cause of obstructive jaundice and are frequently associated with advanced pancreatic and biliary malignancies. Endoscopic retrograde cholangiopancreatography (ERCP) with biliary drainage remains the preferred palliative and therapeutic intervention for restoring bile flow, relieving symptoms, and facilitating further oncological management.

Aims: The study aims to evaluate the technical performance, early safety profile, and short-term clinical contribution of endoscopic biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant biliopancreatic strictures.

Study Design: Retrospective, single-center, descriptive observational study.

Place and Duration of Study: Department of Gastroenterology I, Mohammed V Military Teaching Hospital, Rabat, Morocco, between January 2020 and December 2025.

Methodology: Consecutive patients who underwent ERCP for confirmed malignant biliopancreatic stricture were reviewed. Demographic, clinical, biological, radiological, endoscopic, stenting, complication, rescue drainage, and one-month outcome data were extracted from standardized medical records. Technical success was defined as successful completion of ERCP with effective endoscopic biliary drainage.

Results: Among 140 screened patients, 78 met the inclusion criteria. Mean age was 66 years, and 58 patients were male (74.3%). Cholestatic jaundice was present in all patients, while weight loss and abdominal pain were each reported in 56 patients (71.8%). The main etiologies were pancreatic cancer (43.6%) and cholangiocarcinoma (20.5%). ERCP was technically successful in 64 patients (82.05%). Distal common bile duct strictures predominated (53%). Plastic stents were used in 32 patients (50%), uncovered self-expandable metal stents in 28 (43.75%), and mixed plastic-metal stenting in 4 (6.25%). Immediate post-procedure evolution was uncomplicated in 48 patients (75%). Early complications included cholangitis, post-ERCP pancreatitis, bleeding, and perforation.

Conclusion: ERCP-based biliary drainage was feasible and clinically useful in this Moroccan tertiary-care cohort, with acceptable technical success and early morbidity. Earlier referral, systematic risk reduction, appropriate stent selection, and multidisciplinary rescue pathways after failed ERCP are essential to optimize outcomes.

Seronegative Primary Biliary Cholangitis: Epidemiological, Clinical, Therapeutic, and Prognostic Characteristics

2026-06-09T11:34:34+00:00

Background: Seronegative primary biliary cholangitis (snPBC) is an uncommon variant of PBC in which characteristic antimitochondrial antibodies are absent despite clinical, biochemical, and histological features consistent with the disease. The lack of serological markers may delay diagnosis and raises questions regarding its epidemiological profile, therapeutic response, and long-term prognosis compared with seropositive PBC.

Aims: To describe the epidemiological, clinical, biological, histological, therapeutic, and prognostic characteristics of strictly seronegative primary biliary cholangitis (PBC) and compare them with seropositive PBC.

Study Design: Retrospective observational single-center descriptive comparative study.

Place and Duration of Study: The study was conducted in the Department of Functional Digestive Explorations at Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco. Patients followed for PBC between January 2010 and February 2026 were included.

Methodology: Adult patients diagnosed with PBC according to international criteria were retrospectively identified from hospitalization registries, outpatient databases, and archived medical records. Patients were classified into two groups: seropositive PBC (positive AMA and/or anti-gp210/sp100 antibodies) and strictly seronegative PBC (negative AMA, anti-gp210, and anti-sp100 with compatible histology). Baseline demographic, clinical, biochemical, immunological, imaging, histological, therapeutic, and prognostic data were collected. Biochemical response to ursodeoxycholic acid (UDCA) at 12 months was assessed using Paris II criteria. Prognostic evaluation included GLOBE and UK-PBC scores. Data were analyzed descriptively due to the limited sample size.

Results: Among 40 patients with PBC, 22 had seropositive PBC, 8 had strictly seronegative PBC, 9 had PBC-autoimmune hepatitis overlap syndrome, and 1 had PBC-primary sclerosing cholangitis association. Strictly seronegative PBC represented 20% of the overall cohort and 26.7% of pure PBC forms. Compared with seropositive PBC, seronegative patients had a longer diagnostic delay (36 vs 14 months), more frequent advanced fibrosis (Metavir F3–F4: 75% vs 25%), and higher rates of portal hypertension (62.5% vs 31.8%) and advanced liver disease at diagnosis. Complete biochemical response to UDCA according to Paris II criteria was less frequent in the seronegative group (28.6% vs 57.1%). Histology was essential for diagnosis in all strictly seronegative cases.

Conclusion: Strictly seronegative PBC is an uncommon but clinically important phenotype of PBC. Although its clinical and biochemical presentation is broadly similar to seropositive PBC, delayed diagnosis is associated with more advanced fibrosis and liver disease at presentation. Liver biopsy remains indispensable for diagnosis in the absence of specific autoantibodies. Early recognition and timely management are essential to improve outcomes. Larger multicenter studies are needed to better define the prognosis and therapeutic response of this rare phenotype.

Primary Biliary Cholangitis in Men: Clinical Features, Disease Severity, and Management

2026-06-30T08:19:37+00:00

Background: Primary biliary cholangitis is a chronic autoimmune cholestatic liver disease that predominantly affects women; however, male patients may present with delayed recognition and more advanced disease. Data on primary biliary cholangitis in men remain limited in North African settings. This study aimed to describe the clinical, biochemical, immunological, histological, therapeutic, and prognostic characteristics of male patients with primary biliary cholangitis managed at a tertiary care centre in Morocco.

Methods: This retrospective descriptive single-centre study included 40 patients diagnosed with primary biliary cholangitis between January 2021 and December 2025. Six male patients were identified and analysed. Diagnosis was based on chronic cholestatic liver test abnormalities, primary biliary cholangitis-specific autoantibodies when available, compatible liver histology in selected cases, and exclusion of extrahepatic biliary obstruction or primary sclerosing cholangitis. Clinical presentation, biochemical and immunological findings, histological stage, treatment, biochemical response, and prognostic scores were reviewed. Quantitative variables were summarised as medians and ranges, and qualitative variables as numbers and percentages.

Results: Male patients represented 15.0% of the cohort, with a female-to-male ratio of approximately 5.7:1. The median age at diagnosis was 47.5 years (range: 20–65 years). Pruritus was present in five patients, asthenia in four, and jaundice in three. Cirrhosis and signs of portal hypertension were documented at diagnosis in three patients. Antimitochondrial antibodies were positive in four patients; one antimitochondrial antibody-negative patient had anti-sp100 positivity, and one required histological confirmation. Liver biopsy was performed in four patients, and advanced Ludwig stage III–IV disease was found in three. All patients received ursodeoxycholic acid. Among four patients evaluable at 12 months, two achieved a complete biochemical response, one had a partial response, and one had no response.

Conclusion: In this small retrospective male subgroup, primary biliary cholangitis was frequently symptomatic and advanced at diagnosis. These findings support early recognition of unexplained cholestasis in men, prompt treatment with ursodeoxycholic acid, and long-term surveillance for disease progression and hepatocellular carcinoma, particularly in patients with cirrhosis. Given the small sample size, these observations should be regarded as hypothesis-generating and confirmed in larger prospective multicentre studies incorporating direct male-versus-female comparisons.

Acute Toxicity Screening and Hepatoprotective Potentials of Ethanol Seed Extract of Persea americana on Doxorubicin-Induced Male Wistar Rats

2026-07-08T12:40:53+00:00

Doxorubicin is an effective anticancer drug, but its clinical use may be limited by tissue toxicity, including liver injury. This study evaluated the acute toxicity profile and possible hepatoprotective effect of ethanol seed extract of Persea americana in doxorubicin-induced male Wistar rats. Acute toxicity screening was conducted using oral doses ranging from 10 to 5000 mg/kg body weight. For the hepatoprotective study, thirty-six male Wistar rats were divided into six groups. Group A served as the normal control, while Group B received doxorubicin at 4 mg/kg body weight intraperitoneally once weekly for five weeks. Group C received doxorubicin and vitamin E at 100 mg/kg body weight on alternate days. Groups D, E and F received doxorubicin and ethanol seed extract of P. americana at 400, 800 and 1200 mg/kg body weight, respectively, on alternate days. At the end of the treatment period, blood samples were collected, and serum activities of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were determined. No mortality or observable signs of acute toxicity were recorded at the tested extract doses up to 5000 mg/kg body weight. Doxorubicin administration increased serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase activities compared with the normal control group. Co-administration of vitamin E or the ethanol seed extract reduced aspartate aminotransferase and alanine aminotransferase activities compared with the doxorubicin-only group. However, alkaline phosphatase activity did not differ significantly among the doxorubicin-treated groups, although it was significantly lower in the normal control group. These findings suggest that ethanol seed extract of P. americana may reduce serum aspartate aminotransferase and alanine aminotransferase activities associated with doxorubicin-induced hepatocellular injury in male Wistar rats.

An Atypical Case of Prolonged Cholestatic Hepatitis Following Acute Hepatitis a Infection and the Role of Corticosteroids: A Case Report

2026-04-21T10:50:32+00:00

Hepatitis A virus (HAV) infection is a common cause of acute viral hepatitis in children and usually follows a benign, self-limited course (Schiff, 1992, Wang et al., 2015, Tong et al., 1995). However, atypical manifestations are increasingly recognized, and prolonged cholestatic hepatitis is an uncommon but clinically important variant that may result in persistent jaundice, severe pruritus, and prolonged morbidity despite preserved liver synthetic function (Gordon et al., 1984, Singh et al., 2019, Schiff, 1992). This report describes a 6-year-old boy with serologically confirmed acute hepatitis A who developed sustained conjugated hyperbilirubinemia, pruritus, and intermittent low-grade fever beyond three weeks of supportive care. Evaluation excluded autoimmune hepatitis, Wilson disease, biliary obstruction, chronic liver disease, and other common infectious etiologies. Because of persistent symptoms and delayed biochemical recovery, oral prednisolone was started at 2 mg/kg/day, following which the child showed rapid clinical improvement and progressive normalization of liver function tests. This case highlights the importance of recognizing prolonged cholestatic hepatitis as a distinct clinical pattern of HAV infection and suggests that short-course corticosteroid therapy may be considered in carefully selected refractory pediatric cases (Chirag and Arun Babu, 2023, Gordon et al., 1984).

Small Segment VIII Hepatic Hydatid Cyst with Impending Budd–Chiari Managed Conservatively

2026-07-11T03:56:12+00:00

Background: Budd–Chiari syndrome (BCS) results from hepatic venous outflow obstruction and is rarely associated with external compression by hepatic hydatid cysts. Small cysts at the hepatic dome may cause early venous indentation before thrombosis or classical radiological features develop.

Case Presentation: A 46-year-old woman from rural West Bengal presented with dull right upper-quadrant pain and abdominal fullness for two months. Triphasic computed tomography revealed a 40 × 25 mm non-calcified mixed solid-cystic lesion in segment VIII and a 4.7 mm simple cyst in segment II. The hepatic and portal veins were patent, but the segment VIII lesion abutted and indented the right hepatic vein near its junction with the inferior vena cava. Doppler ultrasound demonstrated mildly reduced phasic flow without thrombus. In view of endemic exposure, weakly positive Echinococcus IgG, and imaging findings, an early or transitional hepatic hydatid cyst with impending Budd–Chiari physiology was suspected. Because hepatobiliary surgery was unavailable and the patient declined invasive treatment, cyclical albendazole therapy with clinical and sonological follow-up was undertaken.

Discussion: Over 18 months, the symptoms resolved, liver test results remained normal, and the lesion regressed, with normalisation of right hepatic venous Doppler flow. This case highlights the need for careful hepatic venous assessment in dome-based cystic liver lesions and suggests that selected small active cysts with early venous compression may be managed conservatively with close surveillance when invasive treatment is not feasible.