Professor Stephen Ryder
Consultant in liver diseases at Nottingham University Hospitals NHS Trust and Medical Advisor to the British Liver Trust
The symptoms of primary biliary cholangitis/cirrhosis (PBC) may not immediately make you think of liver disease – but early diagnosis could just save your life.
You might think it’s just an itch, but if it happens regularly, seems to ‘move’ around your body and doesn’t come with a rash, you might want to get tested for primary biliary cholangitis/cirrhosis (PBC), says Dr Stephen Ryder, Consultant Physician in Hepatology and Gastroenterology.
Connecting the symptoms to liver
PBC is an easily treatable disease of the liver but, because symptoms do not obviously suggest a liver problem, it often goes undiagnosed and for too long. This can result in severe liver problems requiring a transplant, or even liver failure, resulting in death. Dr Ryder says: “We can see people who have suffered for years, when for most people treatment can restore a normal life both in terms of quality and years.”
In a healthy individual, bile is produced inside the liver to help digest fats and remove waste products from the body. This liquid then passes out of the liver through small tubes called bile ducts.
We can see people who have suffered for years, when for most people treatment can restore a normal life both in terms of quality and years.
However, in PBC the body’s immune system mistakenly attacks the bile ducts, which become damaged. This causes bile to build up in the liver, ultimately leading to further liver damage. The tell-tale itching associated with PBC is a result of excess bile seeping into the blood stream, triggering nerve endings into a response that the body interprets as an itch.
Other symptoms can include significant daily fatigue, dry eyes and mouth, poor sleep, pain or discomfort in the upper right side of the tummy and dizziness when standing up.
Who’s at risk?
As with other autoimmune diseases, PBC is more commonly seen in people with a family history of them. It’s 10 times more common in women, particularly in those aged 40-50 years old. However, diagnoses are increasing, says Dr Ryder, in line with better testing and the general increase in autoimmune conditions, which also include type 1 diabetes and thyroid problems. Currently, PBC affects around one in 3,000-4,000 people.
Treatment for PBC generally involves life-long treatment with tablets, but these produce mostly manageable side effects, reassures Dr Ryder. He says: “Yes, taking tablets comes at a cost, but it is far better to get onto treatment early for the best chance of regaining a normal life. My advice to people who are worried is to go and see their GP as early as possible. A test could save your life.”
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