Evaluation of a patient with suspected primary biliary cholangitis (PBC)

This algorithm summarizes an approach to evaluating patients with suspected PBC. Some patients with PBC have associated conditions such as Sjögren's syndrome (dry eyes and mouth), arthritis, and Raynaud phenomenon. This algorithm is intended for use in conjunction with UpToDate content on the clinical features and diagnosis of PBC.

PBC: primary biliary cholangitis; PSC: primary sclerosing cholangitis; ULN: upper limit of normal.

* Common conditions that may warrant a liver biopsy include obesity, nonalcohol-associated fatty liver disease, and heavy alcohol use.

¶ While a liver biopsy is not required to make the clinical diagnosis of PBC, it may provide useful information with regard to staging and prognosis. A clinical diagnosis of PBC can be established in a female patient with an alkaline phosphatase ≥1.5 ULN, with an antimitochondrial antibody ≥1:40, and without extrahepatic biliary obstruction or other comorbidity affecting the liver.

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Evaluation of a patient with suspected primary biliary cholangitis (PBC)