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Fibroids, abdominal pain, food intolerance. PBC?

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General & Family Physician
Practicing since : 2008
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I am a 45 year old, otherwise healthy (my only other condition is fibroids, which are largely asymatic) female of normal weight. I am reasonably fit and look young for my age.
I have just seen a couple of studies, WWW.WWWW.WW being the most recent, that implicate bacterial or viral infection as a cause for PSC & PBS.
In 2000, I was involved with a man who was later diagnosed with PSC and colitis. We practised anal sex and anilingus on more than one occasion. Our intimate relationship finished in July 2000, 3 months before his diagnosis, although we did occasionally kiss (mouth to mouth) until about Dec 2000 when the relationship ended completely.
Around Sep 2003, I started to notice a slight pain in the upper right quadrant that seemed to come and go (tending from sharply tender to dull, with itching confined to that area on occasion). When it was still there in Jul 2004, I had an ultrasound done; no liver or gallbladder disorder was found. The pain has continued to come and go since then. I was on occasion concerned enough to check the internet (which at that the time, pointed to URQ pain as being caused by agents other than the liver) and to make changes to my lifestyle, such as eliminating alcohol for a time, and more recently, dairy produce (other than a small amount of cheese and other processed dairy products).
I have found the pain seems to be caused or aggravated by 4 things:
*eating high amounts of dairy produce (I also get digestive symptoms)
*drinking (on a few occasions!) high levels of alcohol; i.e. a bottle of wine or slightly more each day over a few days (otherwise, I typically drink within recommended guidelines)
*sustained physical activity (e.g. walking at speed or while carrying a heavy weight for several hours - I do 30 minutes aerobic activity every day and get no symptoms)
*on occasion, stress
It seems unrelated to whether I’ve eaten or not, i.e. doesn’t become better or worse when I eat.
When, however, as I previously stated, I recently almost entirely cut out dairy produce from my diet, and I had absolutely no incidence of the pain, I concluded that it was perhaps after all a food intolerance. I have been under considerable stress lately, with job insecurity, my mother being ill, and relationship problems, and unfortunately, started to drink heavily over the past week or so. The pain has come back, and is definitely in the liver area, and after checking the internet over the past few hours I don't doubt any more that it's significant liver damage.
However, when these symptoms first manifested in 2003, I had only been a regular drinker for 5 years (i.e. typically within regular guidelines, more heavily on a few occasions). Before that, I was almost tee total, and indeed didn’t even like any alcohol until I was about 26! From what the specialist told my former boyfriend prior to his PBS diagnosis, normal drinking will not cause significant liver damage in the vast majority of people, so I have to wonder if my symptoms could be PBC or a similar condition, and, if my current boyfriend should be concerned (i.e. to what extent should we prohibit physical contact)?
Sorry for the long post.
Many thanks
Posted Tue, 1 May 2012 in Liver and Gall Bladder
Answered by Dr. Raju A.T 6 hours later

Thanks for your query.

I have gone through the article that you have referred in your query.I do agree with the study but still it can be considered as a hypothesis only unless proved in suspected cases.It can not be considered as a tool to diagnose or establish a active relation between suspected PBC/PSC and the Chlamydia in any case with symptoms resembling that of PBC/PSC.

The pain you have in the right upper quadrant could also be due to alcohol induced hepatitis and is supported by the fact that the symptoms reduced on restricting the dairy products and the alcohol in past.PBC/PSC do not present with such a direct relation with the alcohol but I do consider a need for them to be ruled out as you were at risk of exposure to the condition in your ex boyfriend who might had been infective during the contact.

I would ask you to get confirmed about the suspected diagnosis by getting tested for the same.Like getting a Ultrasound scan , LFT with GGT, antimitochondrial antibody(AMA), antinuclear antibody(ANA),Chlamydia anti-LPS antibodies and a ERCP. Based on the results of the above mentioned tests the exact diagnosis the further management can be planned.

Since the suspected condition in you ( PBC/PSC) is solely antibody mediated I do not consider your present boy friend to be at risk by any chance.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.
Above answer was peer-reviewed by
Follow-up: Fibroids, abdominal pain, food intolerance. PBC? 11 hours later

Many thanks for going through the article and your detailed and helpful answer. I shall definitely follow your advice.
However, you say my current boyfriend need not be concerned about risking cross infection, but I should point out that my relationship with him began around 2001, not long after I finished with XXXXXXX (who had the PSC). If there's a possibility that I could have been infected with a PSC type condition, is there not also a chance that I in turn could pass that on during intimate contact?
I do see what you're saying though about how PSC presents (Simon had a lot of the markers for high blood bilirubin, including all over itching and xanthelasma whereas I only have that pain), although again, maybe I could be at an earlier stage than he was at diagnosis..?
Thanks again, XXXXXXX
Answered by Dr. Raju A.T 12 hours later
Hi again,

Thanks for following me up.

The disease is caused immune response ( antibodies) of the body to the infection and stay even after the infection is gone.Its the antibodies which carry on the disease process.So it doesn't mean that if you have the disease you should have the infection and be infective.Moreover its very unlikely for an infection to stay in the body for years.

Since you say you were in relationship with your second boyfriend since 2001, the chances of infection were high that time as you would have been freshly infected then ( if )but if he was infected he would have shown symptoms by now and as now the chances of you being non infective ( disease mediated by antibodies ),I would consider your second boy friend being at risk is very rare.

Yes, I still do consider the PSC being a possibility in you.You may be in less severe form with only few symptoms but you being at early stage 10 years after exposure is much less than possible.

Hope I answered your doubts completely.

Wish you good health.
Above answer was peer-reviewed by
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