Geo-Epidemiology and Environmental Co-Variate Mapping of Cholestatic Liver Disease
Autoimmune liver disease (AILD) is thought to result from a complex interplay between genetics and the environment. In the Journal of Hepatology, Dyson, et al., identified 2,150 patients with PBC and 472 with PSC with significant spatial clustering was seen for each disease. This study looked for potential environmental triggers in patients with primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) living in the north-east of England and north Cumbria. They found that PBC was more common in urban areas with a history of coal mining and high levels of cadmium whereas PSC was more common in rural areas with lower levels of social deprivation. This study adds to our understanding of potential environmental co-variates for both diseases suggesting that different triggers and alternative pathways determine phenotypic expression of autoimmunity in the affected population. This is an interesting study, which should be replicated in other areas.
Read the paper by Dr. Dyson