AGA/AASLD Clinical Practice Guideline on Management of Primary Biliary Cholangitis.

What was studied

This is a guideline for managing primary biliary cholangitis (PBC) in adults. PBC is a long-term cholestatic liver disease. It can bring fibrosis, cirrhosis, liver transplant and early death. Effective drugs exist. But challenges remain. These cover finding antimitochondrial antibody-negative disease and judging response to ursodeoxycholic acid (UDCA). They also cover risk grouping and care when response is inadequate. Itch (pruritus) from cholestasis is another. So is recurrence after liver transplant. The AGA and the AASLD convened a panel. Reviews were done for 6 key clinical questions. The GRADE framework rated the evidence.

What they found

The panel agreed on 6 statements. They cover antinuclear antibodies in suspected antimitochondrial antibody-negative PBC. They cover UDCA as initial therapy. They cover liver stiffness measurement for prognosis. They cover PPAR agonists for weak response to UDCA or intolerance. They cover linerixibat for moderate to severe itch. They cover UDCA after transplant to lower recurrence.

What it means for patients

The authors say the guideline puts weight on early diagnosis. It also backs tuned initial therapy and step-up care by risk. It backs symptom care too. It also backs preventing recurrence after transplant. They say the aim is better outcomes and quality of life.

Why it is not certain yet

Certainty in the evidence was moderate to very low. The guideline rests on reviews of 6 questions. A review can only be as good as the studies in it.

Source

AGA/AASLD Clinical Practice Guideline on Management of Primary Biliary Cholangitis.

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