Skip to main content

Primary Biliary Cholangitis

  • Chapter
  • First Online:
Liver Disease

Abstract

Primary biliary cholangitis (PBC) , previously known as primary biliary cirrhosis , is the most common autoimmune liver disease. PBC is characterized as a chronic inflammatory autoimmune cholestatic liver disease where immune-mediated injury to biliary epithelial cells leads to cholestasis and fibrosis , and if left untreated, PBC will progress to end-stage liver disease. The disease affects predominantly middle-aged women, with data suggesting 1 in 1000 women over the age of 40 live with PBC. Importantly, clinical presentation ranges from being completely asymptomatic to significantly affecting the patient’s quality of life via pruritus , fatigue, abdominal pain, and sicca symptoms (dry mouth, dry eyes) in addition to liver-related complications. In this chapter, we describe the classic presentation of an asymptomatic patient with a cholestatic pattern of liver injury. We discuss the initial work-up and differential diagnosis for this pattern, the diagnostic criteria for PBC, and specific treatment, with an emphasis on early referral to a liver specialist to ensure the proper management of this progressive liver disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Further Reading

  1. Boberg KM, Chapman RW, Hirschfield GM, Lohse AW, Manns MP, Schrumpf E. Overlap syndromes: the international autoimmune hepatitis group (IAIHG) position statement on a controversial issue. J Hepatol. 2011;54(2):374–85.

    Article  Google Scholar 

  2. Carey EJ, Ali AH, Lindor KD. Primary biliary cirrhosis. Lancet. 2015;386(10003):1565–75.

    Article  CAS  Google Scholar 

  3. Corpechot C, Carrat F, Poujol-Robert A, Gaouar F, Wendum D, Chazouillères O, et al. Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis. Hepatology. 2012;56(1):198–208.

    Article  Google Scholar 

  4. Dufour DR, Lott JA, Nolte FS, Gretch DR, Koff RS, Seeff LB. Diagnosis and monitoring of hepatic injury. II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring. Clin Chem. 2000;46(12):2050–68.

    CAS  PubMed  Google Scholar 

  5. Hirschfield GM, Beuers U, Corpechot C, Invernizzi P, Jones D, Marzioni M, et al. EASL clinical practice guidelines: the diagnosis and management of patients with primary biliary cholangitis. J Hepatol. 2017;67(1):145–72.

    Article  Google Scholar 

  6. Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2016;112:18.

    Article  Google Scholar 

  7. Lammers WJ, van Buuren HR, Hirschfield GM, Janssen HLA, Invernizzi P, Mason AL, et al. Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: an international follow-up study. Gastroenterology. 2014;147(6):1338–49. e5.

    Article  CAS  Google Scholar 

  8. Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ. Primary biliary cirrhosis. Hepatology. 2009;50(1):291–308.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cynthia Levy .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Scheinberg, A.R., Levy, C. (2019). Primary Biliary Cholangitis. In: Cohen, S., Davitkov, P. (eds) Liver Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-98506-0_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98506-0_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98505-3

  • Online ISBN: 978-3-319-98506-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics