Complications of Primary Biliary Cholangitis: What to Know

Reviewed by: HU Medical Review Board | Last reviewed: May 2024

Primary biliary cholangitis (PBC) is a chronic condition that impacts the bile ducts in the liver. Although PBC primarily affects the liver, it can cause complications throughout the body. Many people will not notice any signs of PBC in its early stages. But over time it can lead to other health problems.1,2

Primary biliary cholangitis and liver damage

PBC causes inflammation in the bile ducts that run through the liver. Bile ducts are tube-like structures that transport bile from the liver to parts of the digestive system. As the ducts become damaged, bile can back up in the liver. This causes liver damage. It also increases the risk of developing painful gallstones and bile duct stones.1-3

Liver damage can progress to serious scarring called cirrhosis. Cirrhosis increases your risk of developing liver cancer. Signs of cirrhosis include:1-3

  • Yellow skin (jaundice)
  • Swelling in the legs and feet (edema)
  • Fluid buildup in the stomach or abdomen
  • Internal bleeding in the stomach or esophagus

Primary biliary cholangitis and digestion issues

The liver makes bile that the small intestine uses to help digest fat. PBC can limit bile from reaching the small intestine, causing problems with digestion. People with PBC may have deficiencies in vitamins like A, D, E, and K. These are called fat-soluble vitamins, and your body needs to use bile to process them.1-3

If the body struggles to process fat properly, fat malabsorption may result. Symptoms of fat malabsorption include:1-3

  • High cholesterol – About 80 percent of people with PBC have high cholesterol.
  • Fat deposits under the skin
  • Weight loss
  • Fatty stool or diarrhea

The inability to absorb vitamins, particularly vitamin D, can also lead to bone thinning (osteoporosis).2,3

Portal hypertension

When PBC progresses to cirrhosis, the resulting scar tissue can restrict blood vessels in the liver, and normal blood flow to the liver backs up. This puts pressure on the portal vein, the primary blood vessel that carries blood from these other organs into the liver. Restriction of the portal vein can lead to high blood pressure in this vein or veins connected to it. When this happens, it is called portal hypertension.1,2

Portal hypertension does not allow enough blood flow into the liver to be filtered properly. This can cause a buildup of toxins in the blood.1,2

Portal hypertension can lead to:1,2

  • Enlarged liver or spleen
  • Getting sick more often
  • Bruising or bleeding easily
  • Red blood vessels on the skin (spider angiomas)
  • Bleeding in the gastrointestinal system
  • Occasional mental confusion
  • Swollen legs
  • Fluid buildup near the stomach
  • Enlarged veins in the stomach or esophagus (varices). If these burst and start bleeding, they can be life-threatening and require emergency medical care.

Managing primary biliary cholangitis complications

There is no cure for PBC, but there is treatment aimed at slowing disease progression. Taking your regular PBC treatment helps prevent complications. Your doctor will still monitor you for complications, and if complications develop, there are ways to treat them. Treatment methods may include:2-4

  • Calcium and vitamin D supplementation to help preserve bone strength
  • Medicine to treat bone loss
  • Medicine to lower blood pressure in the portal vein
  • Liver transplant to address serious liver damage in some people

Lifestyle changes such as eating whole foods, getting gentle exercise, and avoiding alcohol and smoking can help keep you healthy overall. If you are worried about complications from PBC, talk to your doctor about treatment and prevention.4

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