Overview
PBC (formerly primary biliary cirrhosis) is a slow autoimmune attack on the small bile ducts inside the liver. Bile builds up and damages liver cells. Without treatment, decades of damage can lead to cirrhosis. With treatment started early, most patients live normal lives.
Symptoms
Often silent for years
Fatigue (most common, can be severe)
Itching (intense, often worst at night)
Dry eyes and dry mouth (Sicca syndrome — overlaps with Sjögren's)
Late: jaundice, easy bruising, fluid retention
Self-Care Tips
Take ursodeoxycholic acid every day.
Avoid alcohol.
Get hepatitis A and B vaccines.
Bone density check — at risk of osteoporosis.
Vitamin A, D, E, K levels — fat-soluble vitamins are often low.
When to See a Doctor
Seek medical care promptly if you notice: Jaundice.
Why it happens
Genetic predisposition + environmental triggers. The signature blood marker is anti-mitochondrial antibody (AMA).
How common it is
Rare — about 30-40 per 100,000. 90% are women, usually diagnosed 40-60 years old.
How it is diagnosed
Blood tests: elevated ALP and GGT, positive anti-mitochondrial antibody (AMA), elevated IgM. FibroScan for fibrosis. Liver biopsy not always needed.
Lifestyle and daily habits
Address quality-of-life symptoms early.
• Take ursodeoxycholic acid every day.
• Avoid alcohol.
• Get hepatitis A and B vaccines.
• Bone density check — at risk of osteoporosis.
• Vitamin A, D, E, K levels — fat-soluble vitamins are often low.
Diet
Mediterranean diet; supplement what you lack.
• Calcium and vitamin D for bone health.
• Fat-soluble vitamins if low.
Medicines
Ursodeoxycholic acid is first-line for everyone.
• Ursodeoxycholic acid (UDCA) 13-15 mg/kg daily — first-line, lifelong.
• Obeticholic acid for non-responders.
• PPAR agonists (elafibranor, seladelpar) — newer options.
• Itching: cholestyramine, rifampin, naltrexone.
• Calcium + vitamin D supplements.
Procedures and surgery
Procedures for advanced disease.
• FibroScan annually.
• Liver transplant for advanced cirrhosis or intractable itching.
Latest science
Obeticholic acid (Ocaliva) and PPAR agonists (elafibranor, seladelpar) are second-line options for ursodeoxycholic acid non-responders. Improving outcomes substantially.
Outlook
With early ursodeoxycholic acid treatment, most patients have normal life expectancy. About 30% don't respond well to ursodeoxycholic acid alone and need second-line drugs. Cirrhosis develops in untreated or refractory cases.
Questions to ask your doctor
• Am I responding well to UDCA — based on what blood tests?
• Should I have a bone density scan?
• Do I need second-line therapy?
Source and review
This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the SGA Hepatology Panel. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.
Frequently Asked Questions
What is Primary Biliary Cholangitis (PBC)?
How is Primary Biliary Cholangitis (PBC) diagnosed?
What is the outlook for Primary Biliary Cholangitis (PBC)?
When should I see a doctor about Primary Biliary Cholangitis (PBC)?
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