When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Wilson disease

Last reviewed: 1 Apr 2025
Last updated: 03 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • elevated serum aminotransferases
  • history of hepatitis
  • acute liver failure
  • behavioral abnormalities
  • presence of Kayser-Fleischer rings
  • tremor
  • dysarthria
  • dystonia
  • incoordination
  • sloppy or small handwriting
Full details

Other diagnostic factors

  • cognitive impairment
  • depression
  • personality change
  • dysdiadochokinesis
  • abnormal extraocular movements
  • normal sensation, muscular strength, and reflexes
  • history of gastrointestinal bleeding
  • jaundice
  • liver tenderness
  • spider angiomata
  • gynecomastia
  • ascites
  • peripheral edema
  • bruising
  • encephalopathy
  • dysphagia
Full details

Risk factors

  • ATP7B gene mutation
  • family history of Wilson disease
Full details

Diagnostic tests

1st tests to order

  • LFTs
  • 24-hour urinary copper
  • slit-lamp exam
  • serum ceruloplasmin
Full details

Tests to consider

  • CBC
  • liver biopsy
  • MRI brain
  • non-ceruloplasmin-bound copper concentration (NCC)
  • DNA testing for ATP7B mutations
Full details

Emerging tests

  • direct measurement of ATP7B peptide

Treatment algorithm

ACUTE

hepatic failure, severe (Nazer score ≥10 or New Wilson Index score ≥11)

hepatic failure, mild to moderate (Nazer score ≤9 or New Wilson Index score ≤10)

ONGOING

symptomatic (neurologic disease or hepatic disease without liver failure)

asymptomatic

Contributors

Authors

Michael L. Schilsky, MD, FAASLD

Professor of Medicine and Surgery

Divisions of Digestive Diseases and Transplant and Immunology

Yale School of Medicine

New Haven

CT

Disclosures

MS is an author of multiple references in this topic.

Uyen Kim To, MD

Assistant Professor of Medicine

Division of Digestive Diseases

Yale School of Medicine

New Haven

CT

Disclosures

UKT declares that she has no competing interests.

Acknowledgements

Professor Michael Schilsky and Dr Uyen Kim To would like to gratefully acknowledge Professor George Brewer, a previous contributor to this topic.

Disclosures

GB is an author of several references cited in this topic.

Peer reviewers

Jeff Bronstein, MD, PhD

Director of Movement Disorders

David Geffen School of Medicine

University of California, Los Angeles

Los Angeles

CA

Disclosures

JB has received grants from and consulted for Alexion and Ultragenix. JB is an author of a reference cited in this topic.

Giacomo C. Sturniolo, MD

Professor of Gastroenterology

Department of Surgical and Gastroenterological Sciences

University of Padua

Padova

Italy

Disclosures

GCS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Schilsky ML, Roberts EA, Bronstein JM, et al. A multidisciplinary approach to the diagnosis and management of Wilson disease: executive summary of the 2022 practice guidance on Wilson disease from the American Association for the Study of Liver Diseases. Hepatology. 2023 Apr 1;77(4):1428-55.Full text  Abstract

Shribman S, Marjot T, Sharif A, et al; British Association for the Study of the Liver Rare Diseases Special Interest Group. Investigation and management of Wilson's disease: a practical guide from the British Association for the Study of the Liver. Lancet Gastroenterol Hepatol. 2022 Jun;7(6):560-75. Abstract

Socha P, Janczyk W, Dhawan A, et al. Wilson's disease in children: a position paper by the Hepatology Committee of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Feb;66(2):334-44.Full text  Abstract

European Association for the Study of the Liver. EASL clinical practice guidelines: Wilson's disease. J Hepatol. 2012 Mar;56(3):671-85.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Wilson disease images
  • Differentials

    • Hepatitis B
    • Hepatitis C
    • Hemochromatosis
    More Differentials
  • Guidelines

    • ACR Appropriateness Criteria®: abnormal liver function tests
    • Multidisciplinary approach to the diagnosis and management of Wilson disease
    More Guidelines
  • Patient information

    Hepatitis C: what is it?

    Hepatitis C: what treatments work?

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer