Primary biliary cholangitis (PBC) is a chronic (long-term) liver disease that slowly gets worse over time. It causes damage to the liver. You may already know that the liver is unique because it can regrow after part of it is injured.

Even though the liver is strong, ongoing injury can make it harder to repair itself. Instead of growing new healthy cells, the liver may develop scar tissue, called fibrosis. Damage from PBC can’t be cured or undone, but treatment can help slow down or delay how quickly the disease gets worse.

How Does PBC Cause Liver Damage?

PBC is a condition that damages your bile ducts — the network of canals that carries bile from the liver to your small intestine. Your liver makes bile, a liquid that helps with digestion and removing waste products.

Researchers believe PBC is an autoimmune disease that causes your immune system to attack healthy cells in your bile ducts. Doctors aren’t sure exactly why some people get PBC. It may happen when certain genes and things in the environment cause the immune system to stop working properly. As your immune system continues to attack your bile ducts, they can stop working as well as they should. This makes it harder for bile to flow from your liver and into your small intestines.

PBC can damage the liver when bile backs up, leading to a buildup called cholestasis. Bile contains acids that help break down fats. When bile can’t flow properly and starts to collect in the liver, it irritates liver tissue and causes inflammation.

Over time, the inflammation causes damage to the liver and is replaced by scar tissue. In the later stages of PBC, this buildup of scar tissue can lead to cirrhosis, where the liver becomes hardened and doesn’t work as well as it should. If cirrhosis continues to worsen, it can eventually lead to liver failure, a serious condition that requires medical attention.

Not everyone with PBC will develop liver failure. However, as PBC progresses, you may experience new symptoms.

Symptoms of PBC

The most common symptoms of PBC are fatigue (a deep exhaustion that doesn’t improve with rest) and pruritus (itchy skin). These symptoms can happen even in the early stages of PBC.

Some symptoms of PBC are caused by a lack of bile in your digestive system. Without bile, your body has a difficult time absorbing fat, which can lead to the following symptoms:

• High cholesterol levels in your blood — Caused by bile not breaking down fats properly
• Xanthomas — Fat deposits in your skin
• Diarrhea — May include greasy stools
• Difficulty absorbing fat-soluble vitamins — For example, vitamins A, D, E, and K
• Osteoporosis — Weak bones caused by low levels of vitamin D (which helps with calcium absorption)

Additional symptoms of PBC include:

• Dry eyes and dry mouth
• Stomach pain
• Bone and joint pain
• Jaundice (yellowing of the skin and whites of the eyes)
• Hyperpigmentation (darkening of the skin)
• Hypothyroidism (low thyroid levels)
• Weight loss

As the disease progresses and more scar tissue replaces healthy tissue in your liver, leading to cirrhosis, more complications can develop, such as portal hypertension. Portal hypertension is high blood pressure in the portal vein — the main blood vessel that carries blood through the liver.

Portal hypertension can cause the following problems:

• Varices — Enlarged veins in your digestive tract that can cause bleeding
• Ascites — A buildup of fluid that causes a distended abdomen
• Edema — Swelling caused by fluid buildup (swollen feet, ankles, and legs)
• Splenomegaly — An enlarged spleen
• Mental confusion — Caused by a buildup of toxins in your blood

PBC Can’t Be Reversed

Your liver is the only organ in your body that can regenerate. However, with continuous damage over time caused by your immune system and bile buildup, your liver doesn’t have enough healthy cells to heal itself appropriately. Instead, it begins to form scar tissue. Once the fibrosis is advanced, it is called cirrhosis, and that is when the scarring is permanent and interferes with the liver’s ability to function.

There’s no cure for PBC. If PBC is caught early and before it causes serious liver scarring, treatment and good care may help slow down the disease.

Treatments To Slow PBC

Treatment options for PBC include medications and surgery:

• Elafibranor (Iqirvo)
• Liver transplantation
• Seladelpar (Livdelzi)
• Ursodiol (also known as ursodeoxycholic acid or UDCA)

Obeticholic acid (Ocaliva) was approved by the U.S. Food and Drug Administration (FDA) in 2016 to treat people with PBC whose symptoms don’t improve with ursodiol. In September 2025, however, the manufacturer withdrew the drug, following a request from the FDA. The agency had safety concerns about the drug and questions about its long-term effectiveness.

Ursodiol

Ursodiol is the first treatment for PBC. It helps improve the flow of bile, reduce the accumulation of toxic bile acids, and protect liver cells from injury. Ursodiol can’t cure PBC, but it can slow the progression of PBC in people with early-stage disease.

Elafibranor

Elafibranor is a PBC treatment approved by the FDA in June 2024. It may be taken alone or in combination with ursodiol. It belongs to a group of drugs called peroxisome proliferator-activated receptor (PPAR) agonists. This group of drugs may help reduce inflammation and the toxic effects of bile acids.

In clinical trials involving people with PBC, elafibranor was shown to reduce levels of alkaline phosphatase, which is a marker for disease progression. Elafibranor was well-tolerated without significant safety concerns. The most common reactions were nausea, vomiting, diarrhea, and abdominal pain. There are currently more ongoing clinical trials for this drug to determine its long-term effects and safety.

Seladelpar

Seladelpar is another PPAR agonist that was approved to treat PBC in August 2024. This PBC medication may be combined with ursodiol or prescribed by itself.

Clinical trials have found several benefits of seladelpar for PBC management, including:

• Less reported fatigue, sleep problems, and itching
• Lower alkaline phosphatase levels
• Reduced bilirubin levels

In clinical trials, most people were able to take seladelpar without serious side effects. The most common side effects were headache, abdominal pain, and nausea. Researchers are still studying its long-term safety and effects.

Liver Transplant

You may need a liver transplant if your PBC symptoms don’t improve with medication or if your condition gets worse. A liver transplant involves surgery to replace your diseased liver with a healthy liver donated by another person.

However, even with a new liver, PBC can come back in some people. If PBC does return after you receive a liver transplant, it usually progresses more slowly.

Treatments To Manage PBC Symptoms

Although PBC treatments can help prevent further progression of the disease, they may not help with other symptoms. Ursodiol may not help with the most common symptoms — fatigue and itching. Additional treatments can help you manage the symptoms that bother you.

Itching can be one of the most frustrating symptoms of PBC. While medications may help relieve it, no single treatment works for everyone. These drugs are often used as supportive or add-on therapies and may not provide complete relief on their own.

Options include:

• Antihistamines — Includes diphenhydramine, hydroxyzine, or loratadine, which may help with sleep or mild itch
• Cholestyramine — A bile acid binder that can reduce itch in some people
• Rifampin, naltrexone, or sertraline — Sometimes prescribed when other treatments don’t help

If you have dry eyes and mouth, artificial tears and saliva substitutes can help. Sucking on hard candy or chewing gum can also help with dry mouth symptoms.

Talk to your doctor about the best treatment for you based on your symptoms.

Lifestyle Changes for PBC

Healthy lifestyle habits can help prevent PBC complications, improve your symptoms, and help you feel better while living with PBC.

Diet Changes

When you’re diagnosed with PBC, your doctor may recommend changes to your diet, including:

• Reducing sodium (table salt) — Helps limit fluid buildup from edema or ascites
• Drinking plenty of water — To improve dry eyes and mouth, and reduce fatigue
• Limiting high-fat meals — May ease diarrhea and help manage cholesterol
• Eating a balanced diet — Ensures you get the nutrients you need
• Avoiding liver irritants — Foods and drinks your doctor may recommend limiting or avoiding with PBC

Physical Activity

When you have PBC, you have an increased risk of osteoporosis. To help prevent bone loss, your doctor may recommend regular exercise, such as walking and weight lifting, most days of the week.

Physical activity can also improve your overall health and prevent other diseases, such as heart disease, diabetes, and some types of cancer.

Talk to Your Doctor

Living with PBC can be challenging, but you’re not alone. With the right treatment, healthy habits, and support from your care team, it’s possible to manage symptoms and protect your liver. Talk to your doctor about the best steps for you.

Find Your Team

On myPBCteam, people share their experiences with PBC, get advice, and find support from others who understand.

What medications do you take for PBC? What lifestyle changes have you made since your PBC diagnosis? Let others know in the comments below.