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Living With Primary Biliary Cholangitis And Cirrhosis


Facts About Primary Biliary Cholangitis

PBC (Primary Biliary Cholangitis) is an autoimmune disease of the liver for which there is no known cause or is considered uncommon, but not rare. It affects It affects 40,000 of 100,000 adults. PBC occurs in women more than men by about 10:1. The diagnosis is usually made in middle age. According to the American Liver Foundation, most patients live 15-20 years before the disease reaches its final stages.

Recently a name change has been adapted for this condition. It is known starting to be known as Primary Biliary Cholangitis. The name change better represents the majority of people who have this disease. Cholangitis reflects the inflammation of the bile ducts of the liver. This occurs from stages 1-3. At stage 4 cirrhosis occurs so that that stage it is then Primary Biliary Cirrhosis. The name change occurred in 2015 and is currently not used universally as yet.

It has been known to occur at age 20.. When it is diagnosed in earlier ages, the need for liver transplant becomes more likely earlier in life.

It is a disease of the biliary ducts of the liver which cause them to inflame and ultimately be destroyed. Many of us are not at the end stage of the disease which actually morphs into nonalcoholic cirrhosis. At that stage of the disease, the only way to cure the damage is to have a liver transplant. This is a slow moving the disease and right now there is only one basic medication that helps slow the progression of the damage in our livers.

Presently, 4% of all the liver transplants in the USA are done for PBC. Since the demand for livers has increased with fatty liver disease and other liver problems increasing, this makes getting a transplant at times difficult.

Cirrhosis In PBC

When the damage of the bile ducts becomes more invasive, the stage for this autoimmune disease becomes Primary Biliary Cirrhosis. Within that category, there are stages (progression) also.

  1. Inflammation-On this level, there will be no signs of damages to the liver yet. However, the organ may start to be swollen or inflamed. There are no notable symptoms or signs yet at this stage since there’s no scar tissue that may show during the clinical procedures or tests being made in the laboratory.
  2. Fibrosis-At this stage, a substantial and marked quantity of hypertension may arise. Portal hypertension may worsen at this stage, which then results in the development of the esophageal varices.
  3. Liver Cirrhosis-There’s now a significant volume of growth or development of the ascites and the fluid accumulation on the parts of the abdominal cavity.The ascites or fluid accumulation level can be determined by some imaging tests like ultrasound
  4. Liver Failure-The scar tissue has spread throughout the liver. This is considered the critical stage of cirrhosis because the liver may fail to function up to its maximum performance level.

What Are The Risk Factors For PBC

There is still ongoing research about PBC and what factors are included for the risk of getting this disease. According to the American Liver Foundation, some risk factors may include :

  • Being between the ages of 30 and 60
  • Having a parent or sibling with this condition
  • Smoking cigarettes
  • Being exposed to certain types of chemicals

Many folks do not fall into those categories. But as we said there is much to learn in the years ahead.

Symptoms of PBC

While each of us vary in the symptoms of this disease that we experience, you might think that we were very healthy to look at us. For a great many of us, the disease is not physically visual until we start getting the end stage of the disease and we turn jaundiced. However for many of us, we suffer fatigue that is hard to explain unless you have experienced it. According to the website, 80 % of us will suffer fatigue. It is a fatigue that can be debilitating to the extent that we are not able to continue our daily tasks. Learning to "pace " ourselves is important to allow ourselves to make the most of our day. The fatigue we experience is not linked to the stage of our disease. It can occur at any time. The best way I can describe it is to say that despite the amount of sleep, you still feel that you need more rest.

Another common symptom is an itching in our skin at various times that does drive us to distraction for sure. While there are some medications that may or may not work, research is working hard to get this debilitating condition under control. It can be very debilitating especially at night, causing the rest we need to be lacking.

Many of us suffer from things like dry mouth, joint stiffness, some aching in the area of our livers, dry eyes and more. Some of us have insomnia. Aches and pains in the joints is not uncommon. Not all patients suffer all symptoms and the amount of symptoms vary with each patient and the stage that they are in. The pain from the liver that we experience is mostly on the left side right under the ribs. It's not from the liver itself, but from an inflammation of the covering of it.

Vitamin difficiencies are not uncommon Vitamins A, D, E, and K are often not absorbed in our bodies. We often have to supplement them to keep going

A few of us have multiple autoimmune conditions which make life challenging, but not impossible.

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How Is PBC Diagnosed?

For many people, including myself, PBC was suspected after a routine blood draw.

Of course, once there is a suspicion that something is not right, your doctor will do a very thorough exam. That could include taking a personal and family history, a physical exam, and a history of any symptoms you may have.

There are additional tests that your doctor may order:

  • Blood tests that measure your liver enzymes and functions
  • antimitochondrial antibody test (AMA) to check for autoimmune disease
  • A liver biopsy-a small piece of liver tissue is removed to be examined.
  • A liver ultrasound looks for changes in the liver.
  • A CT scan to look at your liver
  • An MRI scan to image liver tissue

It is up to your doctor to decide what tests are needed to diagnose the cause of your particular situation.

Getting Familiar With Your Numbers

Your physician will decide the right timetable for you depending on your personal situation.

The numbers from your bloodwork give your physician an understanding on the health of your liver and system. The tests that will give your physician an idea on how you are doing include alkaline phosphatase (ALP), bilirubin and albumin.

  • The ALP(alkaline phosphatase )-A rise in ALP levels indicates impaired bile flow in the liver
  • Bilirubin-Raised bilirubin can sometimes be an indicator of liver damage
  • Albumin-A drop in albumin levels is associated with liver disease which can lead to the scarring of liver tissues (fibrosis or cirrhosis)

It is important to remember that PBC is different for everyone, and healthy ranges can vary. So if any blood work elevates, it is important to speak to your physician to determine the relevance of those numbers to you.

More People Have Autoimmune Diseases Than You Realize

Many People With PBC Have Other Autoimmune Diseases

It is not uncommon for people with PBC to have other autoimmune diseases as well. No one knows why yet, but there is research being done to figure it all out. Sjogrens syndrome, Reynauds, thyroid, rheumatoid arthritis and fibromyalgia are some of the common ones. We also have a tendency to have osteopenia and osteoporosis as well. Not all PBC patients get them, but many do.


The Stages Of PBC

While many of us were diagnosed by several blood tests, there is one real way to know and stage PBC. That of course is a liver biopsy. At some point or another, most of us will have at least one liver biopsy. Once the diagnosis is confirmed and staged, most physicians do not recommend another biopsy. With a newer test called a fibroscan, more and more information is gathered without doing another invasive procedure. So many changes and new procedures are on the horizon that the future hopefully will provide our doctors with new tools to help us get through our lives with brighter outlooks.

As our disease progresses we get fibrosis (scarring ) which causes some stiffness of our livers. The fibroscan measures the stiffness of our livers and is a very promising new technology. Although it has some limitations and is not totally or readily available, the future holds great promise for this technology

Stage I- Mostly shows inflammation, abnormal connective tissue, or both. confined to the portal area of the liver. There is inflammation to the walls of the medium-sized ducts.

Stage 2-Inflammation, fibrosis, or both, confined to the portal and periportal areas. There is a blockage in the small bile ducts.

Stage 3-Bridging fibrosis. This is the beginning of the scarring process.

Stage 4- Cirrhosis has developed. There is permanent scarring.

What PBC Looks Like-Biopsy Slide

What We Do Need Is Liver Donors

Most of us go through a lot of blood work, ultrasounds, fibroscans and MRI's to monitor our condition. Since this disease is slow going, you can live a reasonable life until you get to the stage where a liver transplant is necessary. The need for livers to replace damaged ones is high. Many people do die waiting for liver transplants. There are other conditions such as liver cancer, alcoholic cirrhosis, and more that need new livers too. The fact is that you simply cannot live without your liver. In most states and countries around the world, there are ways that you can become a donor when you get your driving license. You could give the gift of life when you no longer need your liver.

Some generous folks actually give live donations when they are a match. Since only a small part of the liver is needed, and the liver regenerates, it is a possibility. However it is a major surgeryAt this time the need for livers exceeds those available, so in behalf of all liver disease patients, we ask that you consider giving that gift of life

What Does The Future Hold For PBC?

There is continuing research that has made some strides, but there is so much more work that has to be done. Testing for PBC patients is improving and there are some medications that we might be able to look forward to in the near future. But of course, like anything else, all of this takes money.The most recent study that I could find shows 1 in 3–4,000 people have this disease. Since we are a limited group of people with this disease, funding has been limited.

Fibro scans are a new technology that when available are really helping PBC patients. It's a new technology and not as readily available as liver ultrasounds. But when available, it is a helpful tool in tracking liver disease

Currently there is one medication that hold promise. It is still in the testing stage. Primarily it is for patients that are not responsive to the other medication that is available. This , if apprioved by the FDA holds some hope to many patients.

Medications For PBC

Ursodiol has been the medication of choice for many years. While it does not cure PBC, for many, it keeps the progression of the disease at bay for many years. It is a bile acid that helps move bile from the liver into the small intestine.

A second medication has been approved by the FDA. It is for those patients who have had little or no response to the Ursodiol. We have been waiting for 20 years for medication and now we have a new option. his drug lowers the amount of bile in the liver by reducing bile production and helping push bile out of the liver.

The problem with these medications is that they are very pricey. There are no generics. The copays can be very pricey even with insurance.

PBC Medication Information

My Personal PBC Journey

I was diagnosed with PBC at age 64 due to an abnormal blood test while having a workup for another condition. After several additional blood tests, the diagnosis was made. My stomach doctor was careful to explain everything that he could and in truth, at that moment I was glad it wasn't something worse. My journey with this chronic disease has been challenging, but my everyday life still has been fulfilling. Even though I am currently dealing with several other autoimmune conditions, I am focusing on my blessings rather than the challenges. I don't know what tomorrow may hold, but I am ok today.

Your PBC Medical Team

Once you have the diagnosis of PBC, it is time to set up the medical team to continue your specific care.

A lot of whom you will need in addition to your medical doctor will depend on the insurance coverage that you have. Some insurance plans will only cover specialists with a referral. So start with your medical doctor and discuss who needs to be on your team and how you will be referred.

It is also time to understand your insurance. Since there will be additional testing , blood work and office visits, it is important to understand what and how your insurance will cover your needs. Take time to read your policy. If you have any questions, make sure to write them down. Check with the online website for your insurance or call your insurance agent with any questions you may have.

Your Internist or regular doctor generally may only have a limited amount of knowledge about PBC so you will need additional care physicians to cover your needs.

A gastroenterologist is a doctor who specializes in disorders of the stomach and intestine. They are often involved in PBC management.

A hepatologist is a doctor who specializes in disorders of the liver, pancreas, gallbladder and biliary tree. They may be used in place of or in addition to the gastroenterologist.

A rheumotologist is a physician who specializes is diseases of the joints and bones. Because often PBC is associated with other autoimmune diseases, you may have consultations and care with this type of physician also.

Since you may have more than one physician on your team, it is important to make sure that there is good communication between your care team. You need to be proactive in making sure that each of them has the same information on any blood work, test results and changes in your medication.

The Human Liver


More Resources For PBC

  • PBC Foundation - providing support for life
    The PBC Foundation (UK) Ltd is a charity offering support and information to PBC sufferers, their families and friends.
  • American Liver Foundation. Your Liver. Your Life.
    The Web Site of the American Liver Foundation. Great resource for PBC and other liver diseases
    Formed December 1, 1996, the PBCers is now the largest PBC online support group with almost 3,000 members worldwide. Family members and friends are encouraged to join and learn more about PBC. We also accept research donations

Things You Should Know About PBC Patients

If you were to look at me today at Stage 2 PBC with 4-5 other autoimmune diseases, you might not know what is going on. For the most part, until and if I get to the stage where my liver is permanently damaged, if you don't look closely, I might not look sick at all. But there is a lot going on when you look closely. My feet might be swollen from retaining fluids, I might walk slowly because of the fatigue that I am experiencing. You might see the scratches where I have been trying to relieve my itching. Some of my teeth have probably been replaced due to teeth loss. I might have what we refer to as brain fog. You might notice that I do things slowly and stop to rest frequently.

For most of us, we really don't want your sympathy, just your understanding and your help

Primary Biliary Cirrhosis Facebook Groups

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2014 Linda F Correa

Weigh In On PBC

Linda F Correa (author) from Spring Hill Florida on February 24, 2015:

RA is another autoimmune disease that can be less active with meds, true enough. PBC is a little different. The destruction of the bile ducts doesn't really stop, it is only slowed with some meds. Some people are slow responders or non responders to the meds in PBC. I would expect that's the same with RA. So many of us who have auto immune issues, have more than one and that's where it can be challenging

Rabi on February 24, 2015:

What happens is that the dseasie is not active, but there, and flares after the delivery. Autoimmune dseasies are triggered and often dormant.I have RA. It was triggered by strep throat at age 27. I probably got it at about age 23, when it was assumed I had carpal tunnels from being a pastry chef. Turns out, after having the electrical test for carpal tunnels, I didn't have carpal tunnels. I was experiencing the beginning of my RA those years back, without the full-blown symptoms I had once the strep throat came along. Now I have the full-blown RA.Keep in mind that giving birth is a traumatic event to your body and trauma can cause an autoimmune dseasie. People have been triggered into RA by car accidents, believe it or not.

Linda F Correa (author) from Spring Hill Florida on February 07, 2015:

You are welcome. All of try to help each other along the way with information

MARY MANKEY on January 27, 2015:

Thank you , searching for info to educate my family on this newly diagnosed disease and this has a great explanation

Linda F Correa (author) from Spring Hill Florida on September 10, 2014:

You are welcome. There are a great many people struggling with this disease and many more yet to be diagnosed. While it is a chronic and uncommon situation, many of us with the situation. She should get checked. Blood work and an ultrasound can rule this out as well as any other autoimmune condition. She should see her physician as soon as she can. Hope she gets an answer soon

Tamara14 on September 10, 2014:

Thank you Linda for this educational and eye opening hub. I have never heard of PBC before, but now I'm seriously thinking of showing this to my friend who has been struggling for months now trying to find out what is wrong with her and why is she having fatigues so often. She has some serious skin issues as well so I think this might be useful for her to read. Your positive approach is admirable and I wish you all the best.

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