UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

UEG Week Berlin 2025 Recordings Gut Guide online

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Poster

Standard Poster

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

Not sure what you can access? Learn more about account types.

Introduction

Primary Biliary cholangitis (PBC) is a cholestatic condition caused by autoimmune damage of the biliary channels and potentially Precipitating biliary liver cirrhosis and ESLD. The National PBC audit highlighted the nationwide variability in diagnosing and managing PBC (1). The BSG guideline-recommended standard dosing of UDCA (13–15 mg/kg/ day) and prompt liver transplant assessment when indicated (2). Additionally, it endorsed early detection of cirrhosis with related screening to establish and treat hepatocellular carcinoma and oesophageal varices early and it supports adequate control of symptoms such as fatigue or itching which can be challenging (1,2).

Aims & Methods

We obtained medical records from our Electronic Prescription and Medication Administration (EPMA) team for all PBC patients on UDCA between May 2021 and May 2023. A total of 141 patients were identified; 45 and 12 patients were excluded as duplicate and incomplete records, respectively. Only 84 patients were included in this retrospective analysis all with confirmed PBC as defined by the BSG and BASL. Mostly Females (84%) with a mean age of 56.5 years old (35:78). Data were collected from clinic letters and medical records regarding UDCA dose per body weight, symptoms control, refer to liver transplantation, FibroScan and Variceal/HCC screening when liver cirrhosis is a concern.

Results

Our audit revealed that only 78% of the patients were on ideal dosing of UDCA as per documented body weight, additionally, no clear symptoms scoring (fatigue, itching, joint pain, etc) was used. However, in the 19 patients with established biliary cirrhosis on fibroScan, there was good compliance with HCC screening (84%) and oesophageal varices screening (78.9%).
Additionally, only 7 patients were referred for liver transplant assessment or discussed with the tertiary center (see Table 1 for details).

Parameter	result
UDCA dose (13–15 mg/kg/ day)	66/84 (78%)
Associated conditions at diagnosis like Ulcerative colitis	4.7%
Symptoms Burden (fatigue and itching score)	Poor documentation and inconsistency throughout records.
FibroScan for liver cirrhosis (>13 Kpa)	19/84 established LC (22.6%)
Refer for liver transplantation assessment or discussions	7/84 (8.3%)
HCC screening (AFP & US)	17/19 (84%)
Variceal screening (Gastroscopy)	15/19 (78.9%)

Study Results (Table 1): - (UDCA, ursodeoxycholic acid - LC, liver cirrhosis – HCC, Hepatocellular carcinoma, AFP, alpha-fetoprotein- US, ultrasound)

Conclusion

More compliance with the recommended dose of UDCA in our patient is needed to achieve clinical outcomes and normalization of liver functions. there was great compliance with variceal and HCC screens in cirrhotic patients However we also advised prompt early referrals for liver transplant assessment. Furthermore, documentation and scoring of extrahepatic symptoms should be improved.

References

1) Burke, Laura et al. “The National Audit of Primary Biliary Cholangitis (PBC) in the United Kingdom: Defining the Audit Dataset and Data Collection System.” Cureus vol. 14,6 e25609. 2 Jun. 2022, doi:10.7759/cureus.25609.
2) Hirschfield, Gideon M et al. “The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines.” Gut vol. 67,9 (2018): 1568-1594. doi:10.1136/gutjnl-2017-315259.