PBC Canada Diagnosis and Treatment
Care pathway information
- Primary Biliary Cholangitis is a rare autoimmune disease which can lead to liver fibrosis, cirrhosis and endstage liver disease when it’s not treated.
- The goal of the care pathway is to provide a simpler framework that can be adapted by physicians depending on their needs.
- It can also be implemented in a way that would allow care to be integrated, consistent and coordinated.
- The pathway has been created with evidence and recommendations for patient recommendation.
- The goal of the PBC care pathway is to ensure that there is a minimum standard of care that is provided to patients living with the condition in order to have the correct clinician, have things done correctly and timely.
- Guideline adoption can be poor in communities with general gastroenterologists.
- Thus individuals with PBC can be provided with a high quality of healthcare.
1. Reaching a secure diagnosis
Patients with suspected PBC
- 9/10 women aged 35-60
- elevated enzymes
- fatigue, itchiness, jaundice
- liver histology
- history, physical examination and abdominal ultrasound
- serum biochemistry: ALP
- serology: serum AMA and/or PBC-specific ANA
Other possible conditions
- rule out
- presence of other conditions
Further imaging tests or biopsies
2. UDCA therapy, baseline clinical assessment and risk stratification
Initiate 1st Line Treatment
- fatigue, pruritus, sicca
Monitor symptom management medications
3. Response to 1st-line therapy
Assess response to UDCA treatment within 6-12 months
Assess risk of progression based on response to treatment
Reaction to 1st line therapy
- side effects
- symptom changes
4. On-treatment risk stratification
Stratify risk: low, intermediate, high
- consider referral for further assessment
Continue UDCA and assess response every 12 months
Further assessment to evaluate risk-benefit of 2nd line treatment
- further assessment of overall health
5. 2nd-line treatmentInitiate 2nd line therapy in consultation with patient
Treatment assessment and regular follow up
Reaction/side effectds of 2nd line treatment