To Drain or Not Drain: PleurX Indwelling Drainage Catheters for Non-Malignant Refractory Ascites or Hepatic Hydrothorax

Results: Th e search yielded 1095 ACS cases with HBA. Information about gender was available in 384 (35%) cases. Th ere were 142 (37%) men and 242 (63%) women. Th e mean age was 47 (range 16-91) years. Elevated Transaminases were found in 25% (range 5-55%) cases of ACS. In many of these cases, the enzymes became normal on gluten-free diet (GFD). Th e terms used for this condition are Celiac Hepatitis, Reactive Hepatitis or Transaminitis. If basic lab data exclude serious liver disease then these patients may not need extensive liver work-up. Liver biopsy done in a few cases has shown mild infi ltration with infl ammatory cells with no necrosis. Primary Biliary Cirrhosis (PBC) has been seen in 3% cases of ACS. Th is may be due to increased intestinal permeability in CS wherein gut derived antigens may damage the biliary system. Primary Sclerosing Cholangitis (PSC) is seen in 2% of cases of ACS. Both CS & PSC are immune-mediated diseases. Auto-Immune Hepatitis (AIH) is seen in 2% cases of ACS; this may be due to common HLA molecules between AIH & CS. Th e GFD, unlike as in cases of Celiac Hepatitis in general does not improve liver tests in PBS, PSC, and AIH. Th e other HBA noted in CS are (a) Transient gallbladder inertia due to low cholecystokinin production; (b) Fatty liver which may be due to malnutrition; (c) Cryptogenic Cirrhosis; (d) End stage Liver Disease (liver tests may improve in some of these on GFD); (e) Non-alcoholic Fatty Liver; (f) Chronic Hepatitis C; Interferon may activate silent CS; (g) Hemochromatosis; (h) Acute Liver Failure; (i) Hepatocellular Carcinoma. Conclusion: HBA occur in some CS patients.Th e cases of Celiac Hepatitis generally respond to GFD and may not need extensive hepatic work-up. Some other HBA in CS patients may also respond to GFD.