Yvette (54) a journalist from Kent, started experiencing pain in her hip seven years ago in 2015. An ex-national gymnast who had been incredibly active and flexible her whole life, Yvette felt concerned about the growing discomfort impacting her quality of life, and so sought help from her GP.
Primary biliary cholangitis (PBC)
SMALL BILE DUCT DAMAGE
PBC destroys the small bile ducts which link the liver to the gut — the build-up of bile in the liver leads to cirrhosis
About PBC
In primary biliary cholangitis, the body's defence system attacks the ducts that pass out of your liver. It's not clear why this happens, but it causes the ducts to become inflamed and blocked. In turn, bile, the liquid used to help digest fats and remove waste products from your body, builds up in the liver. This can lead to permanent liver damage.
Need to know
Some people with PBC will never get any symptoms of the disease. Clear symptoms of PBC are constant fatigue or tiredness (in some this can be severe) and intense itching in any part of the body. Other symptoms include:
- bone and joint ache
- dry eyes and mouth
- indigestion, nausea or poor appetite
- diarrhoea
- dark urine and pale stools
- arthritis (inflammation of the joints)
- mottled palms with red or pink blotches
- pain or discomfort in the upper right side, below the ribs
- dizziness when standing up (postural or orthostatic hypotension)
- jaundice
Symptoms range from mild to severe but this isn’t always related to the degree of liver damage you have.
PBC is usually diagnosed through blood tests. However, many people are only diagnosed with the disease after having a routine blood test for another reason. Most people with PBC have a high level of certain liver enzymes in the bloodstream, and an antibody called type 2 antimitochondrial antibody.
Once diagnosed, you'll have an ultrasound scan in order to rule out other problems with your bile ducts, and to assess the condition of your liver.
Transient elastography (FibroScan) to measure scarring levels.
A liver biopsy may also be recommended to assess your liver and help your consultant decide on the best treatment. A biopsy involves removing a small sample of your liver tissue to be studied for signs of disease.
Once diagnosed, you'll have an ultrasound scan in order to rule out other problems with your bile ducts, and to assess the condition of your liver.
Transient elastography (FibroScan) to measure scarring levels.
A liver biopsy may also be recommended to assess your liver and help your consultant decide on the best treatment. A biopsy involves removing a small sample of your liver tissue to be studied for signs of disease.
As PBC is a progressive disease, liver damage gets steadily worse over time. Without treatment, liver failure may occur, which can be fatal. There are a number of treatments for managing symptoms of PBC:
- Cholestyramine may be prescribed by your consultant to help ease itching.
- Lozenges, artificial tears and lubricating gels may help dry mouth and eyes.
To slow down disease progression, a medication called ursodeoxycholic acid (URSO, also referred to as UDCA) has been shown to be effective in protecting the liver from the harmful chemicals in the accumulated bile. In people not responding to ursodeoxycholic acid, other medications called fibrates and obeticholic acid are used.
A liver transplant is only recommended if other treatments are no longer helpful.
Patient stories
Yvette's story: From back pain to hip replacement surgery
A new hip and straight back into the spin of things
David’s gym video shows him repeatedly pushing up to 100kg on a single leg press – not particularly unusual for this keen cyclist, former competitive squash player and all-round fitness enthusiast. What is unusual is that 52-year-old David had hip surgery just 12 weeks earlier.
Michael's MAKO hip surgery to treat his arthritis
73 year-old Michael, an avid walker and charity worker, was diagnosed with arthritis in January 2021. After facing long waiting times and increasing pain that was becoming more frequent, he started to look elsewhere for treatment.
This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.