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  1. Reinhild Klein
  1. Correspondence to Professor Reinhild Klein, Department of Internal Medicine, University of Tuebingen, Germany; reinhild.klein{at}

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We very much appreciate the letter by Byrne et al,1 and it was of interest for us to learn that even nowadays, that is >40 years after the first description of antimitochondrial antibody (AMA) in primary biliary cirrhosis (PBC) and identification of their target antigen as an inner mitochondrial membrane antigen (later labelled M2),2 3 early PBC is underdiagnosed and underinvestigated and was formally …

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