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Treatment of PBC
PBC has no curative treatment except liver transplantation, which is the last choice. But, we have medications to slow the disease progression and prevent the complications as possible. Also, the management plan should consider the patient’s symptoms and treat them with specific drugs.
The medical treatment includes:
Ursodeoxycholic acid (UDCA)
It is a bile acid that moves the bile from the liver to the gall bladder and small intestine, which decreases its irritant effect on the liver tissue. It doesn’t cure PBC, but it improves liver functions and slows the progression of cirrhosis. It helps more in the early stages.
PBC is a chronic disease; thus, you will need to take it for life. Its side effects include diarrhea, weight gain, and hair loss.
Obeticholic acid
It is a new drug for those who don’t respond or can’t tolerate UDCA. Also, your doctor may combine it with UDCA.
Immunosuppressants
According to the severity of your disease, your doctor may prescribe medications to suppress your immune system that attacks the bile ducts. These medications have serious side effects; thus, your doctor won’t usually begin with them.
Symptomatic treatment
- For fatigue: There is no medical treatment for fatigue, but lifestyle modifications (proper diet and physical exercise) may improve it. Also, your doctor should control any other health problem that worsens fatigue, such as depression.
- For itching:
- Antihistaminics(such as loratadine and diphenhydramine): They are often used to reduce itching. They also help you sleep if the itching awakens you.
- Cholestyramine: It binds to bile and reduces the itching due to elevated bilirubin. It may affect the absorption of UDCA; thus, if you need it, you should take one hour before UDCA or 4 hours after it.
- For dry eyes and mouth: Use artificial tears and saliva substitutes.
- For vitamin deficiency: You should take supplements to replace the deficient vitamins. Your doctor should also give you calcium and vitamin D to keep your bones healthy and treat osteoporosis if occurred.
- For high cholesterol: Your doctor should prescribe cholesterol-lowering medications, such as statins.
Liver transplantation
If the medical treatment didn’t control your condition or your liver damage became irreversible (extensive cirrhosis and failure), the last choice will be to replace your liver with a healthy one. The long-term outcome is good, but sometimes the disease may recur after many years.
Finally, PBC is a progressive and incurable disease. But, we can keep it under control. To get the best possible results, follow your doctor’s instructions and maintain a healthy lifestyle. Keep your diet healthy, do regular physical exercise, and avoid alcohol and smoking.
