Although primary biliary cholangitis (PBC) and cholecystitis might sound similar, they are two different health conditions affecting two distinct organs.

PBC, previously called primary biliary cirrhosis, is a chronic liver disease thought to be an autoimmune condition. Cholecystitis is a gallbladder condition that can be acute or chronic. Both conditions involve disrupted bile flow that causes inflammation, but they lead to different symptoms and have different outlooks.

Read on to learn about the key differences between PBC and cholecystitis, including differences in their symptoms, diagnosis, causes, and treatment options.

PBC and Cholecystitis Are Different Types of Conditions

Both PBC and cholecystitis are inflammatory conditions and have to do with bile (“chol-” means “bile”), but they happen in different organs. PBC primarily affects the liver, whereas cholecystitis affects the gallbladder.

PBC and cholecystitis are also different types of medical conditions. PBC is an autoimmune disease where the immune system mistakenly attacks healthy tissue in the bile ducts, causing inflammation. PBC is a chronic condition, meaning it doesn’t go away.

Cholecystitis also involves inflammation, but it’s not caused by the immune system attacking the body. It happens when bile gets trapped in the gallbladder. This creates inflammation and can cause infection. Cholecystitis can be acute (short-term) or chronic (long-term), whereas PBC is always chronic.

PBC Symptoms May Take Longer To Become Noticeable

Symptoms of PBC often only show up as the condition progresses or gets worse, and many people won’t have symptoms early on. The most common early symptoms of PBC are itchy skin and fatigue. Because these symptoms aren’t very specific, it can be difficult to know what’s causing them without more testing. Sometimes these general symptoms can lead to a long diagnosis process or even a misdiagnosis.

Symptoms of cholecystitis tend to revolve around the stomach area and gastrointestinal system, including:

• Sudden and intense abdominal pain in the upper-right corner of the abdomen
• Fever or high body temperature
• Nausea or vomiting
• Bloating
• Pain that spreads to below the right shoulder or to the back and gets worse with deep breaths
• Loose and pale poop
• Jaundice (yellowing of the skin and eyes)

Some later symptoms of PBC overlap with those of cholecystitis, including jaundice and pain in the right upper area of the stomach. Talk to a healthcare provider if you have any of the above symptoms so that they can determine the underlying cause and how to treat it.

Cholecystitis Is Usually Caused By Gallstones

The exact cause of PBC is unknown. It’s thought to be a problem of the immune system where the immune system attacks the cells of the bile ducts in the liver, causing inflammation. Doctors think that the autoimmune response may be caused by environmental factors, such as exposure to a certain chemical or infection, in addition to genetic factors, such as a history of autoimmune disease in the family.

Causes of cholecystitis, on the other hand, are clearer and have one main cause. Gallstones cause 95 percent of cases of acute and chronic cholecystitis. Gallstones are hardened pieces of bile made in the gallbladder. They can block the ducts that help drain the gallbladder.

Other causes of cholecystitis include:

• Blocked bile ducts from scarring or thickened bile called “sludge”
• Viral infections that cause gallbladder inflammation, such as AIDS
• Serious illness that reduces blood flow to the gallbladder
• A tumor that keeps bile from flowing out of the gallbladder

PBC Is Fairly Rare, While Cholecystitis Is More Common

PBC is a fairly rare disease. It’s estimated to affect about 15 out of every 100,000 people around the world. According to Cleveland Clinic, PBC primarily affects females — around 60 of every 100,000 females versus 15 of every 100,000 males in the U.S. live with PBC. According to the PBC Foundation, there are about 22,000 people with PBC in the U.K.

Cholecystitis is more common than PBC. Worldwide, about 15 percent of people get gallstones, which are the main cause of both acute and chronic cholecystitis. Around 20 percent of these people develop complications, including cholecystitis. Acute cholecystitis affects about 200,000 people in the U.S. every year.

You Can Have Both PBC and Cholecystitis

People with PBC can get cholecystitis too. A possible complication of PBC is gallstones. Inflammation of bile ducts in the liver can cause blockages and a buildup of bile. The bile may then harden into stones. Gallstones can then cause cholecystitis.

Cholecystitis Risk Is Related To Your Risk of Gallstones

Other risk factors for PBC and cholecystitis are quite different.

Risk factors for PBC are more demographic, including:

• Northern European descent (such as Scandinavia, Northeast England, and Scotland)
• Family history of PBC
• Age 30 to 60

Risk factors for cholecystitis revolve around the likelihood of getting gallstones, which are more common with:

• Hispanic or Native American descent
• Diabetes and/or higher body weight
• Pregnancy
• Quick weight loss
• High cholesterol levels
• Age 40 or older

PBC Can Be More Difficult To Diagnose

PBC can be misdiagnosed as another health condition, especially since there aren’t many, if any, early symptoms. And these symptoms can overlap with those of other conditions. To help with diagnosis, doctors often use antibody tests to look for antibodies linked to PBC, like antimitochondrial antibodies. They may also do a liver biopsy.

Unlike a PBC diagnosis, which usually requires tests and imaging from the start, diagnosis for cholecystitis can often start with a physical exam. The exam involves a doctor using gentle pressure on the upper right part of your abdomen while you take a deep breath. If you experience pain during this exam, that’s called Murphy’s sign, which is a clear sign of cholecystitis. Blood tests and imaging to look at your gallbladder help confirm a diagnosis.

Cholecystitis Can Be Resolved in the Short Term, but PBC Is Chronic

PBC progresses slowly, worsens over time, and can’t be cured. In contrast, acute cholecystitis comes on quickly and suddenly and can be treated quickly to avoid complications.

Chronic cholecystitis can progress slowly as a result of a long-term problem in the gallbladder. For example, a gallstone can partly block the gallbladder, sometimes causing blockages, sometimes not, which can cause chronic cholecystitis. Chronic cholecystitis can also be treated quickly to avoid further complications.

Prognosis and Treatment of PBC

It can take 15 to 20 years for PBC to reach its final stages, but this varies from person to person. Without treatment, PBC can eventually lead to liver failure. The earlier the treatment is started, the better the chances are of slowing the progression of PBC.

Treating PBC is about managing symptoms and slowing disease progression. People with PBC usually take medications to help with symptoms.

Prognosis and Treatment of Cholecystitis

Unlike PBC, which requires long-term management, most people with cholecystitis have excellent outcomes with short-term treatment. Cholecystitis is usually treated with a hospital stay to help control inflammation in the gallbladder.

Treatment for cholecystitis may be as simple as fasting (not eating or drinking for a given period of time), IV fluids, and antibiotic therapy. In most cases, treatment includes a cholecystectomy (a procedure to remove your gallbladder).

Many myPBCteam members have shared about their experiences with gallbladder removal, which for some was part of their PBC diagnosis:

• “My gallbladder and part of my bile duct were removed many years ago due to gallstone impaction.”
• “Gallbladder removed in 2019, which is what has led to PBC as my newest diagnosis, as the pain never went away…”
• “I had my gallbladder removed prior to diagnosis, as they thought that’s what was causing my right upper quadrant pain. When I still had the pain, after some more blood work and liver biopsy, that’s when I got diagnosed with PBC.”

Both PBC and cholecystitis can lead to serious complications if not treated properly and early. Always talk to your doctor about new symptoms or ones that don’t go away, even with treatment. They can help you find a plan that gives you the best chance of feeling better over the long term.

Talk With Others Who Understand

On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with primary biliary cholangitis.

Have you had cholecystitis with PBC? What were your symptoms, and how did you manage them? Share your experience in the comments below, or start a conversation by posting on your Activities page.