Management of primary biliary cirrhosis: from diagnosis to end-stage disease.

Primary biliary cirrhosis (PBC) is one of the most common chronic cholestatic liver diseases affecting the adult population. The clinical presentation of PBC can be diverse, ranging from the presymptomatic individual to the patient with advanced liver disease. Initial evaluation to establish diagnosis and appropriate follow-up are very important in the life-long management of these patients. The primary medical treatment in PBC should focus on reducing the rate of disease progression. To this extent, treatment with ursodeoxycholic acid has been extensively evaluated and has been shown to improve liver biochemistries and survival in patients with PBC. Secondary medical management in PBC should address the treatment of complications of chronic cholestasis, hepatic cirrhosis, and liver failure. Liver transplantation remains the only established therapeutic approach in treatment of patients with end-stage PBC and the associated complications.