Criticism could be raised for the absence of a control arm, but this study set out not to compare fatigue severity across liver disease, but to precisely evaluate fatigue in PBC in the context of the whole patient. Therefore, a control group was not absolutely necessary or appropriate. Future studies Wnt activation will also need

to be particular in having uniform criteria in the definition and assessment of comorbidities and assessing for other causes of fatigue, The presence of fatigue in other liver disease supports our overarching findings. Future studies are required to validate and refine our findings, particularly in clinic populations from different parts of the world, and where possible with longitudinal evaluation of the significance of any observations to outcomes, because this remains a point of concern.8 Additionally the methods we applied to define comorbidities likely underreport such associations, because more formal involved evaluations of patients would be helpful. It was not possible

in this study, for example, to have an in-depth depression evaluation. This does not detract from our findings, because our definitions of comorbidities were conservative. Having objective numerical evaluations of fatigue is difficult, and as is clearly shown in our study, there is a disparity between physician-reported and objective assessment. The analysis, ITF2357 however, is by its nature based on the numerical scores reported, and this represents a limitation in terms of clinical significance at an individual patient level. However, the purposes of such analyses are to guide future research studies and help define and refine the questions they set out to answer. In this way, future work can come closer than we have been able to, in specifying medchemexpress the factors that account for fatigue as a whole. In conclusion,

we confirm that fatigue is a prevalent concern for patients with PBC that is underreported to physicians routinely. We demonstrate that the symptom complex has a multifactorial cause and is not specific to the disease. Careful appraisal in clinic is therefore relevant when addressing this symptom. Furthermore, when evaluating the biological basis of this symptom, or developing novel interventions, studies must account for these demonstrated extrahepatic associations. We thank our patients for their ongoing support of our clinic, Jenny Heathcote for her guidance, and Tamara Arenovich for statistical input. “
“Aim:  Recent studies have revealed that primary biliary cirrhosis patients with anticentromere antibody (ACA) commonly develop portal hypertension. However, the clinical characteristics of autoimmune hepatitis (AIH) remain uncertain.