The report from Pamplona in this issue ofGut 1 gives insight into the spectrum of liver disease in Southern Europe and emphasises the importance of careful laboratory evaluation (see page 429). A total of 1075 consecutive patients who had undergone liver biopsy because of elevated transaminases were assessed retrospectively. In 90% of cases the cause was clear on conventional clinical and serological criteria: most commonly chronic viral hepatitis was responsible with hepatitis C predominating. The study focuses on the remaining 10% in whom the cause was not obvious, in particular using polymerase chain reaction (PCR) on stored serum to detect hepatitis viral sequences, and careful review of the biopsy specimens. The histological review showed cirrhosis in 13, chronic hepatitis in 39, non-alcoholic steatohepatitis (NASH) in 16, and non-specific changes in 33 patients.

The most important finding was the high prevalence of hepatitis B and C sequences, albeit at low levels: 19 patients had hepatitis B virus (HBV) DNA and nine had hepatitis C virus (HCV) RNA in their serum (one had both). None had evidence of HBV or HCV infection by conventional antigen/antibody testing although 30 had evidence …