{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:47:26Z","timestamp":1789001246020,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,4,23]],"date-time":"2014-04-23T00:00:00Z","timestamp":1398211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>In recent years, primary biliary cirrhosis is mostly diagnosed in patients who are asymptomatic; however, a proportion of cases still present with typical complaints such as fatigue and\/or pruritus. We compared biochemical, histological and immunological features of patients with or without fatigue and\/or pruritus at onset to see whether the different clinical presentation may eventually impact on disease progression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed the Bologna cohort of 216 patients with primary biliary cirrhosis referred to our Centre between 1997 and 2007, according to symptomatic (fatigue and\/or pruritus) or asymptomatic presentation. Clinical, biochemical, histological and immunological feature at diagnosis, response to ursodeoxycholic acid and progression of the disorder were compared after a mean follow\u2010up of 81\u00a0\u00b1\u00a075\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At diagnosis, symptomatic patients were significantly more often women (98.6% vs. 87.2%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.004), younger (mean age 49\u00a0\u00b1\u00a012 vs. 55\u00a0\u00b1\u00a012\u00a0years, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.003) and with more pronounced biochemical activity, as indicated by higher alkaline phosphatase (mean 2.93\u00a0\u00b1\u00a02 vs. 2.12, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002) and aminotransferase (mean 1.92\u00a0\u00b1\u00a01 vs. 1.47\u00a0\u00b1\u00a01.27, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.014) levels, whereas histological stage and autoantibody profile were similar. Symptomatic patients were less likely to respond to ursodeoxycholic acid therapy (63% vs. 81%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.006) and developed more often cirrhosis and its complications (31% vs. 13%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fatigue and\/or pruritus at onset identify a subset of patients with primary biliary cirrhosis who preferentially are women, younger, with a particularly active disease, less responsive to ursodeoxycholic acid treatment, and more inclined to evolve to cirrhosis and its complications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12560","type":"journal-article","created":{"date-parts":[[2014,4,3]],"date-time":"2014-04-03T13:16:55Z","timestamp":1396531015000},"page":"636-641","source":"Crossref","is-referenced-by-count":68,"title":["Fatigue and pruritus at onset identify a more aggressive subset of primary biliary cirrhosis"],"prefix":"10.1111","volume":"35","author":[{"given":"Chiara","family":"Quarneti","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum \u2010 University of Bologna Azienda Ospedaliera Universitaria Sant'Orsola\u2010Malpighi Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Muratori","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum \u2010 University of Bologna Azienda Ospedaliera Universitaria Sant'Orsola\u2010Malpighi Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudine","family":"Lalanne","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum \u2010 University of Bologna Azienda Ospedaliera Universitaria Sant'Orsola\u2010Malpighi Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Fabbri","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum \u2010 University of Bologna Azienda Ospedaliera Universitaria Sant'Orsola\u2010Malpighi Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Menichella","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum \u2010 University of Bologna Azienda Ospedaliera Universitaria Sant'Orsola\u2010Malpighi Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Granito","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum \u2010 University of Bologna Azienda Ospedaliera Universitaria Sant'Orsola\u2010Malpighi Bologna 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Pappas","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum \u2010 University of Bologna Azienda Ospedaliera Universitaria Sant'Orsola\u2010Malpighi Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Muratori","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum \u2010 University of Bologna Azienda Ospedaliera Universitaria Sant'Orsola\u2010Malpighi Bologna 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