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This syndrome is infrequent and corresponds to a small subgroup of patients with symptomatic gallstone disease.

Patients with LPAC syndrome present typically with the following main features: age less than 40 years at onset of symptoms, recurrence of biliary symptoms after cholecystectomy, intrahepatic hyperechoic foci or sludge or microlithiasis along the biliary tree.

A defect in ABCB4 function causes the production of bile with low phospholipid content, increased lithogenicity and high detergent properties leading to bile duct luminal membrane injuries and resulting in cholestasis with increased serum gamma-glutamyltransferase (GGT) activity.

Intrahepatic gallstones may be detected by ultrasonography (US), computing tomography (CT), abdominal scan or magnetic resonance cholangiopancreatography. Intrahepatic hyperechogenic foci along the biliary tree may be detected by US, and hepatic bile composition (phospholipid content) may be determined by duodenoscopy.

In all cases where ABCB4 genotyping confirms the diagnosis of LPAC syndrome in young adults, long-term curative or prophylactic therapy with ursodeoxycholic acid (UDCA) should be initiated early to prevent the occurrence or recurrence of the syndrome and its complications. Cholecystectomy is indicated in the case of symptomatic gallstones. Biliary drainage or partial hepatectomy may be indicated in the case of symptomatic intrahepatic bile duct dilatations filled with gallstones. Patients with end-stage liver disease may be candidates for liver transplantation.