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Definition & Facts
What is primary biliary cholangitis?
Primary biliary cholangitis is the new name for primary biliary cirrhosis, or PBC. Primary biliary cholangitis is a chronic disease in which the small bile ducts in the liver become injured and inflamed and are eventually destroyed. When there are no bile ducts, bile builds up and causes liver damage. This damage can lead to liver scarring, cirrhosis, and eventually liver failure. Primary biliary cholangitis is believed to be an autoimmune disease, which means that the immune system is overactive and attacks normal, healthy bile duct cells.
How common is primary biliary cholangitis?
Researchers estimate that in the United States, about 65 out of every 100,000 women and about 12 out of every 100,000 men have primary biliary cholangitis.1
Who is more likely to get primary biliary cholangitis?
You are more likely to get primary biliary cholangitis if you
- are a woman
- are older than age 35
- have a parent or sibling—particularly an identical twin—with the disease
- are of Northern European descent
What other health problems do people with primary biliary cholangitis have?
People with primary biliary cholangitis may have certain autoimmune diseases, including
- autoimmune hepatitis
- autoimmune thyroid diseases—conditions in which the immune system attacks the thyroid gland
- celiac disease
- Raynaud’s disease
- Sjögren’s syndrome
People with primary biliary cholangitis may also have frequent urinary tract infections.
What are the complications of primary biliary cholangitis?
Common complications of primary biliary cholangitis include
These common complications can be prevented and treated.
Symptoms & Causes
What are the symptoms of primary biliary cholangitis?
The most common early symptoms of primary biliary cholangitis are
- feeling tired
- itchy skin
Other common early symptoms may include
As the disease gets worse, symptoms may include
- weight loss
- swelling in the legs, ankles, or feet
- dark urine
- yellowish eyes and skin, called jaundice
- raised patches on the skin called xanthomas
Many people have no symptoms when they are first diagnosed with primary biliary cholangitis. Doctors diagnose up to 6 in 10 people with primary biliary cholangitis before symptoms begin.2 People with primary biliary cholangitis and no symptoms are identified through blood tests. Some people do not have symptoms for years after they have been diagnosed with primary biliary cholangitis.
What causes primary biliary cholangitis?
The exact cause of primary biliary cholangitis is unknown. Experts think that a person’s tendency to have an overactive immune system, which may be genetic, and unknown environmental triggers play a role in causing primary biliary cholangitis. Possible environmental triggers include:
- cigarette smoking
- exposure to certain chemicals
How do doctors diagnose primary biliary cholangitis?
Doctors diagnose primary biliary cholangitis based on your medical and family history, a physical exam, and the results of medical tests.
Your doctor will ask you about your symptoms. He or she will also ask
- whether you have a history of certain autoimmune diseases
- whether one of your parents or siblings has been diagnosed with primary biliary cholangitis
- about your history of infections and exposure to certain chemicals
Your doctor will examine your body, use a stethoscope to listen to sounds in your abdomen, and tap or press on specific areas of your abdomen. He or she will
- look for yellowing of the whites of your eyes and your skin
- check to see if your liver and spleen are larger than they should be
- check for abdominal tenderness or pain, particularly in the upper right side of your abdomen
What tests do doctors use to diagnose primary biliary cholangitis?
Your doctor may recommend the following blood tests:
Anti-mitochondrial antibodies (AMA). Anti-mitochondrial antibodies are found in the blood of about 95 percent of people with primary biliary cholangitis.3
Liver tests. Liver tests can show abnormal liver enzyme levels, which may be a sign of damage in your liver or biliary tract. Higher-than-normal levels of the liver enzyme alkaline phosphatase occur in people with diseases that destroy or block the bile ducts, such as primary biliary cholangitis.
Your doctor may diagnose primary biliary cholangitis if you have anti-mitochondrial antibodies and higher-than-normal levels of alkaline phosphatase in your blood, even if you have no other signs or symptoms of the disease.
Cholesterol. People with primary biliary cholangitis may have higher-than-normal cholesterol levels, which may be a sign that their liver is not working properly.
Your doctor may use imaging tests such as x-rays and ultrasound to help diagnose primary biliary cholangitis by ruling out other causes of bile duct damage, such as gallstones, bile duct strictures, and tumors.
Your doctor may perform a liver biopsy to
- rule out other diseases that may be causing your symptoms
- confirm the diagnosis of primary biliary cholangitis
- determine whether the disease is advanced—as shown by the amount of liver scarring or cirrhosis—or very active
How do doctors treat primary biliary cholangitis?
Doctors treat primary biliary cholangitis with medicines. Your doctor may prescribe ursodiol (Actigall, Urso). Although ursodiol does not cure primary biliary cholangitis, it can slow the progression of liver damage. People who respond to ursodiol early in the course of primary biliary cholangitis can live longer without needing a liver transplant.
If you do not respond to ursodiol, your doctor may prescribe obeticholic acid (Ocaliva). However obeticholic acid does not improve symptoms, and further research is needed to show whether it slows liver disease progression.
How do doctors treat the symptoms of primary biliary cholangitis?
Your doctor may recommend over-the-counter medicines or prescribe medicines to treat symptoms of primary biliary cholangitis.
How do doctors treat the complications of primary biliary cholangitis?
Osteoporosis. For osteoporosis, your doctor may prescribe medicines that slow or stop bone loss and improve bone density. Your doctor may recommend dietary supplements of calcium and vitamin D.
Fat-soluble vitamin deficiencies. For fat-soluble vitamin deficiencies, your doctor may recommend dietary supplements of vitamins A, D, E, and K. Follow your doctor’s instructions on the type and amount of vitamins you should take.
Cirrhosis. If primary biliary cholangitis leads to cirrhosis, doctors can treat the health problems related to cirrhosis with medicines, surgery, and other medical procedures. If cirrhosis leads to liver failure, you may need a liver transplant.
When do doctors consider a liver transplant for primary biliary cholangitis?
Your doctor will consider a liver transplant when your primary biliary cholangitis leads to liver failure. Doctors consider liver transplants only after they have ruled out all other treatment options. Talk with your doctor to find out whether a liver transplant is right for you.
What can I do to help prevent further liver damage?
To help prevent further liver damage, you can do the following:
- Carefully follow your doctor’s instructions, and take your medicines and dietary supplements as directed.
- Quit smoking.
- Do not drink any alcohol or use illegal drugs.
- Have regular checkups, as recommended by your doctor.
- Talk with your doctor before taking
- prescription medicines
- over-the-counter medicines
- dietary supplements
- complementary and alternative medicines
- Try to keep a healthy body weight.
Eating, Diet, & Nutrition
What should I eat if I have primary biliary cholangitis?
You should eat a well-balanced and nutritious diet. Good nutrition is important in all stages of primary biliary cholangitis to help your liver work properly and manage complications. When primary biliary cholangitis leads to cirrhosis, you may develop malnutrition because cirrhosis can cause
- loss of appetite, which will cause you to eat less
- changes in your metabolism
- reduced absorption of nutrients
Your doctor can recommend a healthy eating plan that is well balanced and provides enough calories and nutrients. If you have vitamin deficiencies, your doctor may recommend foods that are high in vitamins A, D, E, and K. Your doctor may recommend that you eat foods high in calcium and vitamin D to help prevent osteoporosis.
What foods should I avoid eating if I have primary biliary cholangitis?
You should avoid eating raw shellfish such as oysters, which can have bacteria that may cause severe infections in people with liver disease. Your doctor may recommend that you make healthy food choices and avoid high-salt foods and foods that are high in fat and carbohydrates, especially those with added sugars.
If you have primary biliary cholangitis, your doctor will recommend that you quit smoking and stop drinking alcohol or, at least, limit your intake to no more than one or two drinks per week. If you have primary biliary cholangitis and cirrhosis, your doctor will recommend complete avoidance of alcohol.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
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Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
John Moore Vierling, M.D., Baylor College of Medicine