Liver and intrahepatic bile ducts - nontumor
Developmental anomalies / cysts
Byler disease

Topic Completed: 1 April 2012

Revised: 22 January 2019, last major update April 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Byler disease liver

Komal Arora, M.D.
Page views in 2018: 951
Page views in 2019 to date: 753
Cite this page: Arora K. Byler disease. website. Accessed September 18th, 2019.
Definition / general
  • Also known as progressive familial intrahepatic cholestasis (PFIC); autosomal recessive disorder of childhood (Orphanet J Rare Dis 2009;4:1)
  • Impaired secretion of bile salts and phosphatidylcholine causes progressive intrahepatic cholestasis
  • Three types of PFIC have been identified:
    1. Deficiency of familial intrahepatic cholestasis 1 (FIC1), Byler disease, as PFIC type 1 (PFIC1)
    2. Deficiency of bile salt export pump (BSEP), Byler syndrome, as PFIC type 2 (PFIC2)
    3. Deficiency of multidrug resistant 3 (MDR3) as PFIC type 3 (PFIC3)
  • Incidence is one per 50,000 - 100,000 births; natural course of PFIC causes portal hypertension, liver failure, cirrhosis, hepatocellular carcinoma and extrahepatic manifestations
  • Treatment: liver transplantation or partial external biliary diversion (J Pediatr Surg 2012;47:501)
Diagrams / tables

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Diagram of types of PFIC

Clinical images

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Hands before and after biliary diversion

Microscopic (histologic) description
  • Enlarged portal tracts with inflammation, ductular proliferation and fibrosis
  • Canalicular cholestasis, absence of true ductular proliferation, periportal biliary metaplasia of hepatocytes, pronounced portal / lobular fibrosis, pronounced portal / lobular inflammation, hepatocellular necrosis, giant cell transformation and perturbed liver architecture (Semin Liver Dis 2011;31:3, Hepatobiliary Pancreat Dis Int 2010;9:570)
Microscopic (histologic) images

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Various images

Electron microscopy images

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Distended bile canaliculi with coarse and granular bile

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