PBC Case Presentation With Dr. Brown

Primary Biliary Cholangitis (PBC) is a chronic, cholestatic autoimmune liver disease that, when diagnosed early, can be effectively managed to improve outcomes and reduce the risk of liver transplantation. In this in-depth video, we follow a representative patient case to highlight how PBC often presents subtly—most commonly in women over 45 with fatigue, pruritus, or mildly abnormal liver tests—and why it is frequently misdiagnosed as fatty liver disease. Viewers will learn why an elevated alkaline phosphatase (ALP), combined with a positive anti-mitochondrial antibody (AMA), is sufficient for diagnosis, and why early intervention is critical.

We explore the clinical utility of immunoglobulin testing, ANA, serum bile acids, and the appropriate use of ultrasound, MRCP, and liver biopsy to confirm diagnosis or rule out overlap syndromes and biliary obstruction. This video offers practical guidance on staging with non-invasive tools like elastography and emphasizes the importance of starting ursodeoxycholic acid (UDCA) as first-line therapy for all diagnosed patients. You’ll also learn when to initiate second-line treatments such as obeticholic acid (OCA), elafibranor, or seladelpar, especially in patients who are incomplete responders or intolerant to UDCA.

Clinicians will also gain strategies for managing PBC-associated symptoms like pruritus and fatigue, monitoring fat-soluble vitamin levels, and determining when to refer patients to a transplant center. The discussion is grounded in clinical trial data and real-world experience, reinforcing the critical role of ALP normalization in predicting transplant-free survival and long-term patient outcomes. Whether you’re a gastroenterologist, hepatologist, or primary care provider managing liver disease, this comprehensive guide offers the latest evidence-based strategies to optimize care for patients with PBC.