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UDCA, PBC, and biochemistry, what does normal mean?
  1. Centre of Internal Medicine
  2. Medical Clinic II
  3. Johann Wolfgang Goethe-Universität
  4. Theodor Stern Kai 7
  5. D-60590 Frankfurt am Main
  6. Germany
  7. Email:

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Editor,—We read the commentary by Lindor (OpenUrlAbstract/FREE Full Text) with great interest and would like to raise the following points.

Lindor is not surprised that in our study1 patients with primary biliary cirrhosis (PBC) who initially had less abnormal liver function tests responded more favourably to ursodeoxycholic acid (UDCA) than those who had initially greater abnormal liver function values. We believe this is interesting as it is known that patients with lower abnormal liver function tests respond less favourably (for example, chronic autoimmune hepatitis to treatment with glucocorticoids) and that values do not decrease in a linear manner. Furthermore, it is well known that UDCA in PBC does not cause normalisation of liver function tests in most patients, and to date there has been no extensive examination of full and incomplete responders. Only in one study was this area addressed but few liver parameters were studied and there was only a short follow up period.2

Lindor states that our finding of no correlation between the percentage …

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