Primary Biliary Cirrhosis: Risks, Symptoms & Treatments

Dr. Michell Shiffman of Bon Secours' Liver Institute of Virginia

Dr. Michell Shiffman of Bon Secours' Liver Institute of Virginia

Primary biliary cirrhosis (PBC) is a disease in which the immune system damages the small bile ducts within the liver.  Bile ducts are tiny tubes within the liver which drain bile into the gallbladder and intestine.  Damage to the bile ducts causes bile to leak into the liver. This damages liver cells and leads to increasing scaring within the liver and eventually cirrhosis. This process takes approximately 20 years. Although the word “cirrhosis” is included in the name of this disease, the vast majority of patients with PBC do not have cirrhosis when the disease is first recognized.

PBC is not contagious. Patients inherit a genetic tendency to develop this disease and many persons with PBC have family members with other immune disorders. Patients with PBC frequently have other immune disorders as well.  The most common of these is Rheumatoid Arthritis.

Many persons with PBC are asymptomatic. Of those persons with symptoms, the most common include fatigue, dry eyes, dry mouth and joint aches.

PBC causes the blood liver enzyme tests to be abnormal. A specific antibody is also present in the blood of patients with PBC.  Patients with PBC also tend to have elevated blood cholesterol. However, the form of cholesterol that is elevated does not increase the risk for heart disease and in most cases does not require treatment.

The treatment for PBC is medication called Ursodeoxychilic acid or URSO. URSO is a non-toxic bile.  It does not damage liver cells and reduces the liver damage caused by human bile. Many large studies conducted in this and other countries have clearly demonstrated that treating patients with URSO reduces liver damage in patients with PBC, prevents patients from developing cirrhosis and reduces the need for liver transplant.  Patients in whom the liver enzymes return to normal or near normal when treated with URSO do not develop cirrhosis and appear to have a normal life expectancy. URSO is a pill taken orally once or twice daily. It has almost no side effects. Less than 5% of patients develop diarrhea or itching.

Dr. Shiffman was involved in studies which demonstrated that URSO was an effective treatment for PBC. Patients suspected of having PBC should undergo a complete evaluation by either Dr. Shiffman or April Long, NP at the Liver Institute of Virginia to determine if this is the correct diagnosis. Patients with PBC can also be receiving URSO can and also and should be monitored on a regular basis.

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About Dr.MLShiffman

Dr. Mitchell Shiffman is the Bon Secours expert on liver disease and liver treatments for Virginia. Prior to joining Bon Secours, Dr. Shiffman was a professor of Medicine at Virginia Commonwealth University (VCU) in Richmond, VA. He was the Chief of the Hepatology Section and Medical Director of the Liver Transplant Program at the VCU Medical Center from 1989 until 2009. During his 20 years at the VCU Medical Center Dr. Shiffman built and directed one of the most respected and productive hepatology programs in the United States. Dr. Shiffman is recognized as one of the world’s leaders in the field of Hepatology. His particular area of research is viral hepatitis. He has been involved with and/or directed numerous clinical trials to develop new and better treatments for viral hepatitis B and C. Dr. Shiffman is a regular speaker on the treatment of viral hepatitis, the management of various liver disorders, and issues related to liver transplantation at regional, national and international society meetings. He has published over 200 articles in medical journals related to the treatment of liver diseases and has edited two books on this topic. In addition, he has contributed to various HCV educational resources including an HCV educational kit. Dr. Shiffman is also a widely recognized expert consultant to pharmaceutical companies on the treatment of liver disease. Dr. Shiffman holds a Bachelor of Arts from State University of New York at Buffalo, a Master of Science in physiology from the University of New Mexico School of Medicine in Albuquerque, N.M. and his Doctor of Medicine from State University of New York Upstate Medical Center in Syracuse, N.Y. He completed his internship and residency in internal medicine and fellowship training in gastroenterology and hepatology at the Medical College of Virginia Hospitals in Richmond, VA. Dr. Shiffman is a member of many professional organizations including: the American College of Gastroenterology, American College of Physicians, the American Gastroenterological Association, American Society for the Study of Liver Diseases, American Society of Transplantation, European Association for the Study of the Liver, International Liver Transplantation Society, Richmond Academy of Medicine, Virginia Medical Society and the Virginia Gastrointestinal Society. He was a member of the Board of Trustees with the American College of Gastroenterology from 2003-2009.

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