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Primary biliary cholangitis: Difference between revisions
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'''Primary biliary cholangitis''' (PBC), previously known as '''primary biliary cirrhosis''', is an autoimmune chronic liver disease characterised by progressive destruction of intralobular bile ducts leading to intrahepatic cholestasis. Eventually, cirrhosis develops. | '''Primary biliary cholangitis''' (PBC), previously known as '''primary biliary cirrhosis''', is an autoimmune chronic liver disease characterised by progressive destruction of intralobular bile ducts leading to intrahepatic [[cholestasis]]. Eventually, [[cirrhosis]] develops. | ||
It almost exclusively affects middle-aged women and is associated with other autoimmune disorders. | It almost exclusively affects middle-aged women and is associated with other autoimmune disorders. | ||
== Clinical features == | == Clinical features == | ||
PBC may present asymptomatically (only abnormal laboratory parameters) as it remains asymptomatic for a long time. Then, nonspecific symptoms like fatigue and pruritus appear. Later, symptoms of cholestasis appear, like jaundice, itching, and xanthelasmas. | PBC may present asymptomatically (only abnormal laboratory parameters) as it remains asymptomatic for a long time. Then, nonspecific symptoms like fatigue and pruritus appear. Later, symptoms of cholestasis appear, like [[jaundice]], itching, and xanthelasmas. | ||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
As with any cholestasis, ALP, GGT, and bilirubin are elevated. However, the following findings are typical for PBC: | As with any cholestasis, [[ALP]], [[GGT]], and [[bilirubin]] are elevated. However, the following findings are typical for PBC: | ||
* Autoantibodies (ANA, AMA) | * Autoantibodies ([[ANA]], AMA) | ||
* Hyperlipidaemia | * [[Hyperlipidaemia]] | ||
* Mildly increased AST and ALT | * Mildly increased [[AST]] and [[ALT]] | ||
Symptoms of cholestasis often prompts morphological examination of bile ducts with ERCP or MRCP, but these are normal in case of PBC. Ultrasound can also be used to in the evaluation | Symptoms of cholestasis often prompts morphological examination of bile ducts with [[ERCP]] or [[MRCP]], but these are normal in case of PBC. [[Ultrasound]] can also be used to in the evaluation | ||
Biopsy and histology are not necessary for the diagnosis but may give information on stage and prognosis. It will show destruction of the interlobular bile ducts. | Biopsy and histology are not necessary for the diagnosis but may give information on stage and prognosis. It will show destruction of the interlobular bile ducts. | ||
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There is no cure for PBC, and so treatment aims at slowing disease progression and improving symptoms. | There is no cure for PBC, and so treatment aims at slowing disease progression and improving symptoms. | ||
Ursodeoxycholic acid (UDCA) is a hydrophilic bile acid which stimulates bile secretion and has a hepatoprotective effect and is used in the treatment of PBC. It slows the progression and improves the symptoms. Obetichoic acid is another option. | [[Ursodeoxycholic acid]] (UDCA) is a hydrophilic bile acid which stimulates bile secretion and has a hepatoprotective effect and is used in the treatment of PBC. It slows the progression and improves the symptoms. Obetichoic acid is another option. | ||
Cholestatic pruritus is a common and possibly disabling symptom. UDCA improves it, but bile acid sequestrants like cholestyramine or rifampin may also help. | Cholestatic pruritus is a common and possibly disabling symptom. UDCA improves it, but bile acid sequestrants like [[cholestyramine]] or [[rifampin]] may also help. | ||
[[Liver transplantation]] is the only definitive treatment but is reserved for end-stage disease or intractable pruritus. | [[Liver transplantation]] is the only definitive treatment but is reserved for end-stage disease or intractable pruritus. | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||