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What is PBC?
Primary Biliary Cholangitis and How Covenant Can Help
Julissa Taveras MSN, APRN-BC
Physician Reviewed
If you’ve recently been told you may have Primary Biliary Cholangitis (PBC), or you’re trying to understand abnormal liver tests, you’re not alone. As a provider, I see many patients who have never heard of PBC until it shows up on routine labs. The goal of this article is to help you understand what PBC is, how it can progress over time, and how we approach diagnosis and treatment at Covenant Metabolic Specialists.
What is PBC?
PBC is a chronic autoimmune liver disease. This means the body’s immune system mistakenly attacks the small bile ducts inside the liver. These ducts are responsible for transporting bile, a substance that helps digest fats and remove waste.
When these ducts are damaged, bile begins to accumulate in the liver. Over time, this leads to inflammation and gradual scarring.
How does PBC progress?
PBC is typically slow-moving, but it is progressive if not adequately treated. Many patients are diagnosed early, often before symptoms develop. However, ongoing bile duct injury can lead to fibrosis (scarring) and eventually cirrhosis, which is advanced liver disease.
Cirrhosis can impair liver function and increase the risk of complications such as fluid retention, confusion, and other serious health concerns. The goal in managing PBC is to intervene early and slow or prevent this progression.
What are the symptoms of PBC?
PBC is often silent in its early stages. When symptoms are present, they may include:
Fatigue
Itching (one of the most common and bothersome symptoms)
Dry eyes or dry mouth
Mild discomfort in the upper right abdomen
Because these symptoms can be subtle, many patients are diagnosed through routine blood work rather than symptoms alone.
How is PBC diagnosed?
From a clinical perspective, the diagnosis of PBC is based on established criteria.
PBC is diagnosed when at least 2 of the following 3 are present:
Elevated alkaline phosphatase (ALP), reflecting bile duct injury
Positive antimitochondrial antibody (AMA), which is highly specific for PBC
Liver biopsy showing findings consistent with PBC
In most patients, a diagnosis can be made with elevated ALP and a positive AMA, so a liver biopsy is not always required. However, biopsy remains an important part of the diagnostic criteria and is used when the diagnosis is unclear, AMA is negative, or when overlap with other liver diseases is suspected.
Imaging is sometimes performed, but it is not used to diagnose PBC—its role is to rule out other causes of abnormal liver tests, such as bile duct obstruction.
At Covenant, we also use FibroScan® to non-invasively assess liver stiffness and detect fibrosis. While it does not diagnose PBC, it is an important tool for staging disease and monitoring progression over time.
What is the treatment for PBC?
The first-line treatment for PBC is ursodiol (ursodeoxycholic acid, or UDCA).
In simple terms, ursodiol helps bile flow more effectively through the liver and reduces the buildup of bile acids that can damage liver cells. It has been the standard of care for many years and is typically the first medication patients are started on.
However, it’s important to understand its limitations. Only about 50–60% of patients achieve an adequate biochemical response to ursodiol alone. That means a significant number of patients continue to have ongoing liver inflammation despite being on therapy.
From a clinical standpoint, this is critical—because incomplete response is associated with continued disease progression, including the risk of fibrosis and cirrhosis.
For this reason, many patients require additional or second-line therapies. There are now approved options beyond ursodiol, and several promising treatments in development that aim to better control disease activity and improve long-term outcomes.
How Covenant Metabolic Specialists can help
At Covenant, we take a comprehensive and proactive approach to managing PBC.
We treat patients across the full disease spectrum, including:
Early-stage PBC identified through routine labs
Patients with incomplete response to ursodiol
Individuals with advanced fibrosis or cirrhosis
Our approach includes:
Advanced non-invasive monitoring with FibroScan® to track fibrosis
Comprehensive lab evaluation to assess treatment response and disease activity
Personalized treatment strategies, including escalation beyond ursodiol when appropriate
Ongoing management of cirrhosis, focused on preventing complications and preserving liver function
We also recognize the role of overall metabolic health in liver disease and incorporate this into our care model to optimize long-term outcomes.
Why early evaluation matters
Because PBC can go undetected for years, early evaluation is key. If you’ve been told you have abnormal liver tests, or you’re experiencing symptoms like persistent fatigue or itching, further evaluation may be warranted.
Early diagnosis allows for earlier intervention—and a better chance at slowing disease progression.
Primary biliary cholangitis is a chronic, progressive liver disease—but it is manageable with the right approach. While first-line therapy like ursodiol plays an important role, it is often not enough on its own. Recognizing when additional treatment is needed is key to preventing progression to cirrhosis.
At Covenant Metabolic Specialists, we combine advanced diagnostics with individualized care plans to support patients with PBC at every stage, from early diagnosis to advanced disease management.
If you’re looking for answers or a clearer plan for your liver health, our team is here to help.
Resources
American Association for the Study of Liver Diseases (AASLD): https://www.aasld.org
American Liver Foundation: https://liverfoundation.org
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): https://www.niddk.nih.gov
PBC Foundation: https://www.pbcfoundation.org.uk
Mayo Clinic – Primary Biliary Cholangitis: https://www.mayoclinic.org
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