We should move toward normalisation of serum ALP levels; yet, while we continue to use dichotomous criteria such as ALP < 1.5/1.67 x ULN in clinic - maybe due to constrained second-line tx regulations or convenience... 🧐 (2)
...we should take special care of those patients with ALP levels < 1.5 x ULN and elevated GGT (3.2 x ULN). These have worse prognosis than those with ALP<1.5 & GGT < 3.2. What to do then? Exclude NAFLD/MAFLD/alcohol/drugs; then consider to escalate treatment for PBC...✍️👌 (3)
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