• "My advice to my gastroenterologist colleagues is to consider the possibility of acute hepatic porphyria (AHP) when they see patients with unexplained and recurrent severe abdominal pain. Diagnosis can easily and rapidly be established using a single-spot random urine test for porphobilinogen (PBG) and creatinine.”Herbert L. Bonkovsky, MD.

 

Recurrent Abdominal Pain of Unknown Etiology: Could It Be Acute Hepatic Porphyria? 

Acute Hepatic Porphyria (AHP), a subset of porphyria, refers to a family of rare, genetic diseases characterised by potentially life-threatening attacks and, for some patients, chronic manifestations that negatively impact daily functioning and quality of life (QOL).1 The most common manifestation of attacks is severe, diffuse abdominal pain, although patients can also experience other pain, mood, and gastrointestinal (GI) symptoms.1 Attacks often require hospitalisation and can lead to permanent neurological damage or even be life-threatening.2,3 Severe abdominal pain is the most common symptom of AHP, presenting in 92% of patients during attacks.7 Patients may also have other GI symptoms such as constipation and vomiting.8

Patients with acute hepatic porphyria are often referred to gastroenterologists with abdominal pain of unknown origin, many of whom have been misdiagnosed for many years.2,4,5 Click here to understand why gastroenterologists are critical to the accurate and early diagnosis of acute hepatic porphyria to potentially improve prognosis.

Role of Gastroenterologists

Why are gastroenterologists critical to the accurate and early diagnosis of AHP?

Background

What are the porphyrias, and what are the different types of porphyrias?

Diagnosis/Prognosis

Why is the identification and diagnosis of patients with AHP so critically important?

Symptoms

What are the typical signs, symptoms, and clinical presentation of AHP?

Testing

What tests should be ordered to diagnose AHP?

Summary

What should gastroenterologists know about AHP?

1. Gouya et al. European Association for the Study of the Liver (EASL) Congress 2018. Presentation. 2. Bonkovsky et al. Am J Med. 2014;127(12):1233-1241. 3. Anderson et al. Ann Intern Med. 2005;142(6):439-450. 4. Balwani M, Wang B, Anderson KE, et al. Hepatology. 2017;66(4):1314-1322. 5. Jaramillo-Calle DA. N Engl J Med. 2017;377(21):2100-2101. 6. Bonkovsky HL, Maddukuri VC, Yazici C, et al. Am J Med. 2014;127(12):1233-1241. 7. Anderson KE, Balwani M, Ventura P, et al. Hepatology. 2016;64(1 suppl):285A. 8. Anderson KE, Bloomer JR, Bonkovsky HL, et al. Ann Intern Med. 2005;142(6):439-450.

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