EOSINOPHILIA IN PRIMARY BILIARY-CIRRHOSIS - REGRESSION UNDER THERAPY WITH URSODEOXYCHOLIC

Eosinophilia can be observed in up to 40% of patients with primary biliary cirrhosis (PBC). Eosinophilia is transient, tends to occur in the early stages of the disease and seems to be associated with episodes of florid bile duct destruction [42-45]. 14 Patients with PBC were examined before and during treatment with ursodeoxycholic acid (UDCA) (10 mg/kg/d) for episodes of eosinophilia and the number of eosinophilic granulocytes in differential white blood cell counts. Group A consisted of 5 patients with one or several episodes of eosinophilia before the start of UDCA. Group B included 9 patients without known episodes of eosinophilia. Observation time before and after start of treatment for group A was 3-96 (mean 25) months and 6-24 (mean 14) months, and for group B 3-108 (mean 34) months and 6-27 (mean 19) months respectively. During treatment with UDCA the mean counts of eosinophilic granulocytes decreased in both groups from 309+/-47/mm(3) to 135+/-14/mm(3) (p<0.001). In group A there was a decrease from 529+/-89/mm(3) to 157+/-17/mm(3) (p<0.001) and in group B from 151+/-15/mm(3) to 128+/-15/mm(3) B (n.s.). In group A 9/18 differential white blood cell counts showed eosinophilia before UDCA medication (3 x relative [greater than or equal to 6%], 6 x absolute [greater than or equal to 500/mm(3)]) and 0/24 after the onset of UDCA (p<0.001). In group B 0/25 differential white blood cell counts showed eosinophilia before UDCA and 2/72 after start of the therapy. In two patients eosinophilia occurred after 2 and 3 months of UDCA therapy respectively (11%, 847/mm(3) and 5%, 525/mm(3)). After a minimal 3 months of UDCA intake no further eosinophilia was observed in either group or in 52 differential white blood cell counts. For all patients treated the number of blood cell counts with eosinophilia decreased significantly during UDCA medication (9/43 vs. 2/98, p<0.001). Under UDCA medication the average number of eosinophils and the episodes of observed blood eosinophilia significantly decreased in I)BC patients. This seems to represent a new and interesting aspect in the active spectrum of UDCA. Assuming that eosinophilia in PBC reflects florid bile duct lesions, normalization of blood eosinophils under UDCA medication may suggest a direct beneficial effect of UDCA on bile duct destruction in PBC.