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Management of primary biliary cirrhosis

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Opinion statement

Primary biliary cirrhosis is a chronic, progressive disease for which there is no definitive treatment. Ursodeoxycholic acid, however, is of benefit for delaying progression to irreversible end-stage liver disease and prolonging survival free of transplantation. It is, therefore, the standard medical therapy for primary biliary cirrhosis. Orthotopic liver transplantation can be offered for patients with end-stage disease. Other important endpoints of treatment in this condition include management of the long-term complications of cholestasis such as pruritus, osteoporosis, and fat-soluble vitamin deficiencies. Pruritus is best treated with cholestyramine; rifampicin, antihistaminics, opioid-antagonists, and ondansetron can also be tried. Osteoporosis should be treated with calcium and vitamin D supplementation. Bisphosphonates or vitamin K2 may be of additional benefit to decrease the risk of fractures, but this is unproved as of yet. Deficiencies of vitamins A, D, E, and K should be treated with appropriate replacement. Finally, orthotopic liver transplant is indicated for cases of liver failure, intractable pruritus, or severe osteoporosis.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, 200 First Street SW, E19 B, 55905, Rochester, MN, USA

    Cynthia Levy MD & Keith D. Lindor MD

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  1. Cynthia Levy MD
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  2. Keith D. Lindor MD
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Levy, C., Lindor, K.D. Management of primary biliary cirrhosis. Curr Treat Options Gastro 6, 493–498 (2003). https://doi.org/10.1007/s11938-003-0051-4

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  • DOI: https://doi.org/10.1007/s11938-003-0051-4

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