What management strategies should be considered for a patient diagnosed with cholestasis due to primary biliary cholangitis?

Management strategies for cholestasis due to primary biliary cholangitis (PBC) focus on slowing disease progression, managing symptoms, and monitoring for complications. The first-line treatment is ursodeoxycholic acid (UDCA), which improves liver biochemistry and delays progression to cirrhosis and liver failure NICE CG165. For patients with an inadequate biochemical response to UDCA, second-line therapies such as obeticholic acid may be considered, as supported by emerging evidence Karlsen et al. 2014.

Symptom management is essential, particularly for pruritus and fatigue. Cholestyramine is commonly used to alleviate pruritus, and other agents like rifampicin or naltrexone may be added if symptoms persist NICE CG165. Fatigue management remains challenging and is primarily supportive Karlsen et al. 2014.

Regular monitoring of liver function tests, symptom progression, and screening for complications such as osteoporosis and hepatocellular carcinoma is recommended. Bone density assessment and supplementation with calcium and vitamin D should be considered due to increased fracture risk NICE CG165. Surveillance for hepatocellular carcinoma is advised in patients with cirrhosis Karlsen et al. 2014.

In advanced cases with liver failure or decompensated cirrhosis, referral for liver transplantation evaluation is indicated. This remains the definitive treatment for end-stage disease NICE CG165.

Overall, management integrates pharmacological therapy to modify disease course, symptom control, complication prevention, and timely specialist referral, reflecting both UK guideline recommendations and contemporary literature insights Karlsen et al. 2014.