Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are two chronic liver diseases that affect the bile ducts, which are responsible for carrying bile from the liver to the small intestine. While they have some similarities, they are distinct conditions with different causes and treatments. In this quick lesson, we will review the differences and similarities of primary biliary cholangitis and primary sclerosing cholangitis (PBC) vs (PSC).
Primary Biliary Cholangitis vs Primary Sclerosing Cholangitis: Similarities and Differences
Introduction: PBC vs PSC
PBC is a autoimmune disorder that occurs when the body’s immune system attacks and damages the small bile ducts in the liver. This leads to scarring and inflammation of the ducts, which can eventually result in liver damage and cirrhosis. PBC is more common in women, and the risk increases with age. Symptoms of PBC may include fatigue, itching, and yellowing of the skin and whites of the eyes (jaundice).
PSC, on the other hand, is a progressive disease that results from inflammation and scarring of the bile ducts. It can occur in both men and women, and is more common in people with inflammatory bowel disease such as Crohn’s disease or ulcerative colitis. PSC can also cause jaundice and itching, as well as abdominal pain and weight loss.
PBC vs PSC: Pathology and Treatment
One of the main differences between PBC and PSC is the cause of the bile duct damage. PBC is an autoimmune disorder, while PSC is caused by inflammation and scarring. This means that the treatments for these conditions may be different. PSC is characterized by damage of medium to large extrahepatic and intrahepatic bile ducts, whereas PBC chiefly targets small intrahepatic bile ducts (Park et al. 2022).
PBC is often treated with medications that suppress the immune system, such as ursodeoxycholic acid (UDCA) or immunosuppressants. These medications can help slow down the progression of the disease and may improve symptoms. In some cases, a liver transplant may be necessary if the liver has been severely damaged.
PSC, on the other hand, is more difficult to treat and there is no cure for the condition. Treatment may include medications to manage symptoms and prevent complications, such as antibiotics to prevent infections or nonsteroidal anti-inflammatory drugs (NSAIDs) to control abdominal pain. In severe cases, a liver transplant may be necessary.
PBC vs PSC: Prognosis
Another difference between PBC and PSC is the prognosis. PBC is generally a slower progressing disease, and many people with PBC can live for many years with the condition. However, PSC is a more aggressive disease and can lead to liver failure and death in a shorter period of time.
There are also some notable differences in the prevalence and risk factors for these conditions. PBC is more common in women and tends to occur in people over the age of 40. PSC, on the other hand, can occur at any age and is more common in men. Risk factors for PSC include a history of inflammatory bowel disease and smoking.
In conclusion, primary biliary cholangitis and primary sclerosing cholangitis are two chronic liver diseases that affect the bile ducts. While they have some similarities, they are distinct conditions with different causes and treatments. PBC is an autoimmune disorder that is treated with medications that suppress the immune system, while PSC is caused by inflammation and scarring and is more difficult to treat. PBC is generally a slower progressing disease, while PSC is more aggressive and can lead to liver failure and death in a shorter period of time.
Summary Table: PBC vs PSC
|Feature||PBC (Primary Biliary Cirrhosis)||PSC (Primary Sclerosing Cholangitis)|
|Risk factors||Female gender, autoimmune disorders||Inflammatory bowel disease, history of appendectomy/inflammatory bowel disease|
|Patient Population||Female gender, over age 40||Any age, more common in men; more likely to have a IBD history such as ulcerative colitis|
|Symptoms||Fatigue, itching, jaundice|
Progressive jaundice, hepatomegaly, cirrhosis
Skin manifestations including xanthomas
|Fatigue, itching, jaundice, abdominal pain|
|Laboratory Findings||Antimitochondrial antibody|
High cholesterol levels
High Alk phosphatase and High aminotransferase
|Beads on a string appearance on imaging (indicative of dilation and stricture of bile duct)|
High aminotransferases (but typically <300)
|Diagnosis||Blood tests, liver biopsy||Blood tests, liver biopsy, endoscopic retrograde cholangiopancreatography (ERCP)|
|Treatment||Ursodeoxycholic acid, immunosuppressants||NSAIDs, immunosuppressants, liver transplant|
|Prognosis||Progressive liver damage, potential for cirrhosis and liver cancer||Progressive liver damage, potential for cirrhosis and liver cancer|
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Excellent article on PSC v PBC! I’ve learned something new today.
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Fantastic comparison of the two! One of my aunts had primary biliary cholangitis. Superb analysis!
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Thank you, Dr. Keys! 😀
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