Primary Biliary Cholangitis (PBC)

What PBC is

Primary biliary cholangitis, or PBC, is a chronic autoimmune disease of the small bile ducts inside the liver. Bile can build up and injure the liver over time.

It is seen mostly in women. It is not an infection, and it is not caused by alcohol. The older name was primary biliary cirrhosis. Most people do not have cirrhosis when PBC is found.

Symptoms and complications

Some people have no symptoms. When changes do appear, a person may notice:

• Tiredness
• Itching, which can be severe
• Dry eyes or a dry mouth
• A dull ache under the right ribs
• Yellow skin or eyes
• Swelling of the belly or legs
• Confusion or unusual sleepiness

Yellow skin, swelling, and confusion are more often signs of advanced scarring. Vomiting blood, or black stools, needs emergency care. If you have urgent symptoms, call 911 or go to an emergency department.

Diagnosis and tests

Blood tests look for a bile-duct problem and for an antibody that is often present in PBC. Those tests do not prove the diagnosis by themselves.

Ultrasound looks at the bile ducts and the liver. A stiffness test can estimate scarring. A biopsy is sometimes used when the blood tests are unclear.

Your family doctor arranges imaging. A clinician reads the tests together, and no single result sets a treatment plan on its own.

Treatment and management

Ursodeoxycholic acid (UDCA) is the usual first medicine. When it is started early, it can slow scarring. Other medicines are used when UDCA is not enough. This page does not list every medicine or a dose.

Itching and other symptoms can be treated on their own. A clinician decides which treatment fits.

Alcohol can injure the liver further. Ask the clinician how much, if any, is reasonable.