Advances in Treatment of Primary Biliary Cholangitis (PBC) - Episode 2

Classification of PBC

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Edward Mena, MD, reviews the classification and diagnosis of PBC considering the change from the term “cirrhosis” to “cholangitis.”

Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: Ed, patients are often very confused when they hear the term cirrhosis. Fortunately, we’ve been able to change the name to primary biliary cholangitis [PBC], and not primary biliary cirrhosis. Of course, when we have staging, we sometimes use the term stage IV to describe cirrhosis. Patients get very worried, because they think of stage IV as something related to cancer, etc. How do you explain disease classification to patients?

Edward Mena, MD: I’m so glad they changed the name from primary biliary cirrhosis to primary biliary cholangitis. When you would tell them in the old days, “you have primary biliary cirrhosis,” they’d all almost go into tears saying, “When am I going to have a liver transplant, because I have primary biliary cirrhosis?” So, changing the name, I think, really helped. When I discuss the different stages, especially of liver disease, for our patients, I try to discuss cirrhosis, and how far you are away from cirrhosis. I personally like to use a little baseball analogy. You’re in high school, minor league baseball, AAA, and then the major leagues are cirrhosis to me. Hopefully, that’ll explain to them how far, or how long it will take for them to get to cirrhosis. Cirrhosis to me is very important for our patients to know, because if they do have cirrhosis, we need to educate them on the surveillance for liver cancer and how often surveillance is done. This also includes how often I want to see the patients.

Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: In terms of classifying the disease as mild, moderate, and severe, do you use a liver biopsy? Which, of course, is not required for the diagnosis, as we’ll talk about. Do you use transient elastography or other tests? How do you explain to patients disease severity?

Edward Mena, MD: I don’t use liver biopsy any longer. I think transient elastography has made life a little easier and better for patients. The great thing about transient elastography is that we do so many in my office that our technicians are experts in doing the procedure. The thing that’s also positive about transient elastography is that you get those results immediately. You’re able to tell the patient if it is mild, moderate, or severe right there at the bedside after they’ve done their transient elastography.

Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: I know, that’s a great advance. I think that’s changed how we practice hepatology for sure.

Transcript edited for clarity