What tests are needed to diagnose primary biliary cholangitis?
If PBC is suspected from your symptoms, a blood test will usually confirm the diagnosis. Most people with PBC have:
- A high level of certain liver chemicals (enzymes) in the bloodstream. See separate leaflet called Liver Function Tests for more details.
- An antibody called antimitochondrial antibody. This antibody is thought to have something to do with causing the disease, as it attacks a part of the internal working apparatus of cells called the mitochondria. It is present in about 19 out of 20 patients with PBC.
- Other unusual antibodies are often found.
- Many people with early PBC also have a raised cholesterol level. However, this is usually mainly the good cholesterol which is called high-density lipoprotein (HDL) cholesterol. This means that despite having higher cholesterol, there is no increased risk of heart disease. See separate leaflet called Cholesterol for more information.
- Many people with PBC have an underactive thyroid gland (hypothyroidism).
Your doctor may arrange for you to have an ultrasound scan of your liver. Gel is applied to the skin of your tummy (abdomen). The ultrasound probe is moved across your skin (similar to the scan that women have during pregnancy). This allows the doctor to look at your bile ducts for signs of scarring and blockage. The doctor can also check for any other possible causes of your symptoms.
A liver biopsy involves taking a small sample of tissue from a part of the liver. This involves a local anaesthetic and the passage of a hollow needle between two lower ribs on the right-hand side. This enables a tiny piece of liver tissue to be taken. The sample is then examined under the microscope to look for abnormal cells.
If PBC is present then typical changes are seen under the microscope. The biopsy can also give an indication of how severe the condition is. For example, whether liver scarring (cirrhosis) has developed, and if so, how badly. See separate leaflet called Liver Biopsy for more details.
A magnetic resonance imaging (MRI) scan and other further specialised testing may be done if your doctors want to rule out other conditions which can be similar to PBC, particularly a condition called primary sclerosing cholangitis (PSC) which is more common in young men and which has a similar name and behaviour but a different cause.
Further reading and references
EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis; European Association for the Study of the Liver (2017)
Management of cholestatic liver diseases; European Association for the Study of the Liver (June 2009)
I J Beckingham and S D Ryder; ABC of diseases of liver, pancreas, and biliary system: Investigation of liver and biliary disease. BMJ 2001322:33-36.
My liver enzymes have been rising since I've been on Enbrel (Enterecept) for Rheumatoid Arthritis. The doctor suspects autoimmune hepatitis because I also have a positive ANA, but thinks it may...LeanaBeana77
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.