Primary biliary cholangitis (PBC)

Small bile duct damage

PBC destroys the small bile ducts which link the liver to the gut — the build-up of bile in the liver leads to cirrhosis

About PBC

In primary biliary cholangitis, the body's defence system attacks the ducts that pass out of your liver. It's not clear why this happens, but it causes the ducts to become inflamed and blocked. In turn, bile, the liquid used to help digest fats and remove waste products from your body, builds up in the liver. This can lead to permanent liver damage.

Need to know

  • What are the symptoms of primary biliary cholangitis? icon plus

    Some people with PBC will never get any symptoms of the disease. Clear symptoms of PBC are constant fatigue or tiredness (in some this can be severe) and intense itching in any part of the body. Other symptoms include:

    • bone and joint ache
    • dry eyes and mouth
    • indigestion, nausea or poor appetite
    • diarrhoea
    • dark urine and pale stools
    • arthritis (inflammation of the joints)
    • mottled palms with red or pink blotches
    • pain or discomfort in the upper right side, below the ribs
    • dizziness when standing up (postural or orthostatic hypotension)
    • jaundice

    Symptoms range from mild to severe but this isn’t always related to the degree of liver damage you have.

  • Diagnosing PBC icon plus

    PBC is usually diagnosed through blood tests. However, many people are only diagnosed with the disease after having a routine blood test for another reason. Most people with PBC have a high level of certain liver enzymes in the bloodstream, and an antibody called type 2 antimitochondrial antibody.

    Once diagnosed, you'll have an ultrasound scan in order to rule out other problems with your bile ducts, and to assess the condition of your liver.

    Transient elastography (FibroScan) to measure scarring levels.

    A liver biopsy may also be recommended to assess your liver and help your consultant decide on the best treatment. A biopsy involves removing a small sample of your liver tissue to be studied for signs of disease.
  • Potential treatment options icon plus

    As PBC is a progressive disease, liver damage gets steadily worse over time. Without treatment, liver failure may occur, which can be fatal. There are a number of treatments for managing symptoms of PBC:

    • Cholestyramine may be prescribed by your consultant to help ease itching.
    • Lozenges, artificial tears and lubricating gels may help dry mouth and eyes.

    To slow down disease progression, a medication called ursodeoxycholic acid (URSO, also referred to as UDCA) has been shown to be effective in protecting the liver from the harmful chemicals in the accumulated bile. In people not responding to ursodeoxycholic acid, other medications called fibrates and obeticholic acid are used.

    A liver transplant is only recommended if other treatments are no longer helpful.


Our HPB consultants

Our medical and surgical consultants specialise in the hepatobiliary system which includes the liver, bile duct and pancreas. 

Our locations

From complex HPB surgery to diagnostic tests and procedures, we provide exceptional hepatobiliary care across our network of hospitals, outpatient centres and specialist clinics.

Book an appointment

Our team can help with any enquiries or you can make an appointment with one of our experienced consultants.

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020 7079 4344
This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
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