Importance of Understanding Impact on Disease Outcomes: Progression to Fibrosis and Cirrhosis

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Welcome to the CLDF GHAPP PBC Podcast Series. In this episode, Dr. Kimberly Brown is joined by Dr. Steven Flamm for an in-depth discussion on primary biliary cholangitis (PBC). Together, they explore the unpredictable progression of PBC to fibrosis and cirrhosis, offering real-world insights into how liver disease develops even in patients who may not exhibit symptoms early on.

The conversation emphasizes the importance of early diagnosis, close monitoring, and timely intervention to improve outcomes. Drs. Brown and Flamm dive into non-invasive methods for assessing fibrosis—including elastography and proprietary serum biomarkers—and discuss why simple tools like APRI and FIB-4 are helpful for initial risk stratification but less reliable for monitoring long-term disease progression. They also discuss the clinical significance of rising bilirubin levels in PBC, the limitations of routine imaging in identifying advancing fibrosis, and the importance of identifying secondary causes of liver disease.

This episode also touches on when to consider second-line therapies, how to identify candidates for liver cancer screening, and the role of transplant centers in managing advanced disease. If you’re a clinician treating PBC or other chronic liver conditions, this conversation provides valuable guidance on how to optimize care and improve outcomes across the entire spectrum of liver disease.