Primary Biliary Cholangitis: 2018 Practice Guidance From the American Association for the Study of Liver Diseases
Keith D. Lindor, Christopher L. Bowlus, James L. Boyer, Cynthia Levy, Marlyn J. Mayo
Abstract
Watch a video presentation of this article Watch an interview with the author In November 2018, the American Association for the Study of Liver Diseases (AASLD) published an update to the 2009 practice guideline on the Diagnosis, Staging, and Management of Primary Biliary Cholangitis (PBC).1 The 2018 updated guidance on PBC includes updates on etiology and diagnosis, the role of imaging, clinical manifestations, and treatment of PBC since 2009. The AASLD 2018 PBC Guidance provides a data-supported approach to screening, diagnosis, and clinical management of patients with PBC. It differs from more recent AASLD practice guidelines, which are supported by systematic reviews and a multidisciplinary panel of experts that rates the quality (level) of the evidence and the strength of each recommendation using the Grading of Recommendations Assessment, Development, and Evaluation system. In contrast, this guidance was developed by consensus of an expert panel and provides guidance statements based on formal review and analysis of published literature on the topics. The quality (level) of the evidence and the strength of each guidance statement are not rated. Intended for use by health care providers, this guidance identifies preferred approaches to the diagnostic and therapeutic aspects of care for patients with PBC. As with clinical practice guidelines, it provides general guidance to optimize the care of the majority of patients and should not replace clinical judgment for a unique patient. The Guidance Statements are included in Table 1. Guidance Statements: The diagnosis of PBC can be established when two of the following three criteria are met: Biochemical evidence of cholestasis based on ALP elevation. Presence of AMA, or other PBC-specific auto-antibodies, including sp100 or gp210, if AMA is negative. Histologic evidence of nonsuppurative destructive cholangitis and destruction of interlobular bile ducts. The major changes from the last guideline to this guidance include information about obeticholic acid and the adaptation of the guidance format. Please listen to Dr. Keith D. Lindor discuss the important updates and impact on patient management from this publication.