Holistic Patient Care in Primary Biliary Cholangitis: Managing Both the Disease and the Symptoms

Abstract

In the progressive, immune-mediated liver disease primary biliary cholangitis (PBC), the intrahepatic bile ducts are gradually destroyed over several years. The primary biochemical means to diagnose PBC, and assess progression and treatment response, is serum alkaline phosphatase (ALP). Further diagnostic criteria depend on antimitochondrial antibody (AMA) and specific antinuclear antibody status, and histological confirmation in some patients. First-line therapy for PBC is ursodeoxycholic acid (UDCA), which has been shown to improve biochemical indices of PBC and slow disease progression. However, major quality of life (QoL)-impacting symptoms of PBC, including pruritus and fatigue, are demonstrated to be independent of disease severity. There is evidence confirming that these symptoms negatively impact a number of aspects, including emotional status, ability to work, and social life, for some patients. In a symposium as part of the European Association for the Study of the Liver (EASL) International Liver Congress™ (ILC) 2022, Gideon Hirschfield, Toronto Centre for Liver Disease, University of Toronto, Ontario, Canada; Ana Lleo, Humanitas University and Humanitas Clinical and Research Centre, Milan, Italy; and David Jones, Newcastle University and Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK, discussed the holistic treatment of patients with PBC and whether goals of such should be more or equally dependent on biochemical status or impact on QoL. This discussion was expanded on in a session moderated by Jessica K. Dyson, Newcastle University and Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.