Diagnosis of Primary Biliary Cholangitis (Primary Biliary Cirrhosis)

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?

Blood tests

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.

A health professional drawing blood from a patient’s arm.
Your doctor may recommend blood tests to diagnose primary biliary cholangitis.

Imaging tests

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.

Liver biopsy

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


March 2017

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 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