The right treatment plan is the best way to manage symptoms of primary biliary cholangitis (PBC). The liver disease, which damages your bile ducts, has no cure, but medication, lifestyle changes, and other treatments can slow it and improve your overall well-being.
How Primary Biliary Cholangitis Affects Your Quality of Life
The symptoms of PBC can affect your quality of life, including everyday tasks. One study looked at how the condition affects peoples’ lives before it gets severe. Researchers found that people with PBC often have joint pain, which causes them to struggle with chores and other daily tasks and need help more often. Study participants also faced challenges at work and with hobbies and exercise.
The study shows that while your quality of life is generally good with PBC, the illness can still have a big impact your daily life, relationships, and work.
Primary Biliary Cholangitis Treatment
Treatment for PBC involves medication for the disease, symptoms, and health problems that come with the illness. If you have severe PBC, you’ll eventually need a liver transplant, which may help you live longer.
PBC Medications
Medication can help stop PBC from getting worse and avoid further health problems. The first drugs you'll take are:
Ursodeoxycholic acid (Actigall, Urso). Also known as UDCA, this is usually the first drug prescribed for PBC. It helps bile move through your liver. This improves how well your liver works and lessens scarring.
Obeticholic acid (Ocaliva). Used alone or with UDCA, it may improve how well your liver works and slow liver scarring.
You may also take:
Budesonide. When combined with UDCA, it may benefit PBC. But we need long-term studies to confirm its safety and how well it works, especially for people with advanced PBC.
PPAR Agonists. How these work isn't completely understood, but experts think that they lessen the amount of bile your body makes. They may improve how well your liver works, but research hasn't shown yet that they reduce liver scarring. You can use them together with UDCA, or alone if UDCA doesn't work for you well enough or you can't tolerate it. Some PPAR agonists you may take are:
- Elafibranor (Iqirvo):This medication lessens the amount of bile made by your liver and helps it to move out bile acid. It also helps to curb liver inflammation.
- Fenofibrate (Tricor): This drug may help ease liver inflammation and itching when you take it with UDCA, but researchers need to study it more. Doctors prescribe it off label for PBC symptoms.
- Seladelpar (Livdelzi): This is a medicine that helps to lessen how much bile your liver makes. It also helps to bring down levels of alkaline phosphatase (ALP) in your blood. This is an enzyme that has a link to the progression of liver disease.
PBC Symptom Treatment
PBC causes a range of symptoms, many of which you can treat with medicine, home remedies, and lifestyle changes.
Fatigue
You’ll probably feel weak and tired with PBC, but there are ways to boost your energy. Look at your daily habits -- what you eat and how much exercise you get. Other illnesses like thyroid disease that often go along with PBC can also sap your energy, so talk to your doctor about getting tested for conditions that cause fatigue.
Itching
Itchy skin is a common symptom of PBC. Treatments include:
Antihistamines. You’ll take this drug to stop itching and help you to sleep.
Cholestyramine. You mix this powder with food or liquids to ease itching.
Rifampin. Researchers think this antibiotic works by blocking your brain’s reaction to chemicals in your blood that trigger itching.
Opioid antagonists. These medications, such as naloxone and naltrexone, work on your brain in the same way as rifampin to relieve itching.
Sertraline. This medication boosts your brain’s serotonin levels to stop you from itching.
Dry eyes and mouth
If you’re having problems with dry eyes, try artificial tears, which you can get over the counter or with a prescription from your doctor. For a dry mouth, chewing gum or sucking on hard candy can help you make more saliva.
Treating PBC Complications
PBC can cause other health problems, such as trouble absorbing vitamins and minerals, high cholesterol, osteoporosis, and more pressure in the blood vessel that carries blood from some organs to your liver (portal vein). Here are some treatments for these complications:
- Vitamins A, D, E, and K, calcium, folic acid, and iron supplements
- Cholesterol-lowering medication such as a statin
- Calcium and vitamin D for bone weakness and loss (osteoporosis)
- Reduced-salt foods for elevated pressure in your portal vein (portal hypertension)
Liver Transplant for PBC
If medicine doesn’t control your symptoms and your liver continues to get weaker, you’ll need a liver transplant. This is where a doctor takes out your unhealthy liver and replaces it with a healthy liver from a donor.
Transplants for PBC often have excellent results, and you’ll live a normal life span. But your illness could come back after surgery, even years later. But your symptoms will advance more slowly.
Primary Biliary Cholangitis Lifestyle Changes
Making changes in your daily life will help to keep you and your liver as healthy as possible. If you have PBC, you should do these:
- Don’t smoke. If you currently do, talk to your doctor about how to quit, and if you don’t currently smoke, don’t start.
- Avoid alcohol. Drinking can damage your liver even more as it processes alcohol.
- Don’t use drugs. This includes illicit drugs and medications taken other than how they’re meant to be used.
- Cut back on certain foods. Limit the amount of processed, packaged, high-sodium, and high-fat foods you eat. Sodium can make tissue swelling and fluid buildup worse.
- Exercise. Include both cardio and weightlifting. Lifting weights can help you to avoid bone loss.
- Avoid eating raw shellfish. It can carry bacteria that’s harmful to people with liver disease.
- Be careful with new medicines or supplements. With liver damage, you might react more strongly to medications and some supplements. Before taking anything new, check with your doctor.
- Stay hydrated. Drinking enough water helps your liver to more easily do its job of flushing toxins from your body.
- Practice good oral hygiene. Infections in your mouth can cause inflammation that may spread to your liver.
- Lessen and manage stress. Ongoing stress can cause changes in your gut that play a role in liver injury.
Show Sources
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SOURCES:
Cleveland Clinic: “Primary Biliary Cholangitis (PBC).”
Mayo Clinic: “Primary biliary cholangitis.”
Mayo Clinic Health System: “Water: Essential for your body.”
American Liver Foundation: “Primary Biliary Cholangitis (PBC).”
Hepatology: “Quality of Life and Everyday Activities in Patients with Primary Biliary Cirrhosis.”
Dentistry Journal (Basel): “Oral Health and Liver Disease: Bidirectional Associations—A Narrative Review.”
Brain and Behavior: “A literature review for the mechanisms of stress‐induced liver injury.”
European Medicines Agency: "Iquirvo."
FDA: "Drug Trials Snapshots: LIVDELZI."
