Back to Search
Start Over
Primary Biliary Cholangitis management: controversies, perspectives, and daily practice implications from an expert panel
- Publication Year :
- 2020
- Publisher :
- Blackwell Publishing Ltd, 2020.
-
Abstract
- Primary biliary cholangitis (PBC) is a rare progressive immune-mediated liver disease that, if not adequately treated, may culminate in end-stage disease and need for transplantation. According to current guidelines, PBC is diagnosed in the presence of antimitochondrial antibodies (AMA) or specific antinuclear antibodies, and of a cholestatic biochemical profile, while biopsy is recommended only in selected cases. All patients receive ursodeoxycholic acid (UDCA) in first line; the only registered second-line therapy is obeticholic acid (OCA) for UDCA-inadequate responders. Despite the recent advances in understanding PBC pathogenesis and developing new treatments, many grey areas remain. Six Italian experts selected the following topics as the most urgent to address in PBC management: diagnosis and natural history of PBC: as a portion of the subjects with isolated AMA, normal alkaline phosphatase (ALP) levels and no symptoms of liver disease could have PBC by histology, defining how to manage and follow this population is crucial; role of liver biopsy: recent evidence suggests that biopsy may provide relevant information for risk stratification and prediction of UDCA response, possibly facilitating personalized approaches; risk stratification: the tools for risk stratification are well established, but some issues (eg bile acid dosage in routine practice) remain controversial; and therapy: those in more advanced stages of development are nuclear receptor modulators and fibrates, but more data are needed to plan personalized strategies. In this manuscript, for each topic, current evidence, controversies and future perspectives are summarized with the possible implications for clinical practice.
- Subjects :
- medicine.medical_specialty
Population
Receptors, Cytoplasmic and Nuclear
Disease
risk stratification
fibrates
liver biopsy
management
obeticholic acid
primary biliary cholangitis
primary biliary cholangiti
Bile Acids and Salts
03 medical and health sciences
chemistry.chemical_compound
Liver disease
0302 clinical medicine
Biopsy
medicine
Humans
Intensive care medicine
education
education.field_of_study
Cholestasis
fibrate
Hepatology
medicine.diagnostic_test
business.industry
Liver Cirrhosis, Biliary
Ursodeoxycholic Acid
Obeticholic acid
medicine.disease
Ursodeoxycholic acid
Bile Acids and Salt
Transplantation
chemistry
Cholestasi
030220 oncology & carcinogenesis
Liver biopsy
030211 gastroenterology & hepatology
business
medicine.drug
Human
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....499f87e48aeea4921476ff5944b21c67