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Updated: Jan 27, 2026

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
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Current and promising therapy for primary biliary cholangitis.

Andrea A Gossard1, Keith D Lindor1

  • 1a Mayo Clinic , Division of Gastroenterology and Hepatology , Rochester , MN , USA.

Expert Opinion on Pharmacotherapy
|April 2, 2019
PubMed
Summary

Primary biliary cholangitis (PBC) management involves ursodeoxycholic acid (UDCA) and obeticholic acid (OCA). Novel therapies and side effect management are crucial for patients with this chronic liver disease.

Keywords:
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Area of Science:

  • Hepatology
  • Gastroenterology
  • Internal Medicine

Background:

  • Primary biliary cholangitis (PBC) is a chronic, cholestatic liver disease.
  • PBC can progress to cirrhosis and end-stage liver disease.
  • Current treatments include UDCA and OCA, with ongoing research into novel therapies.

Purpose of the Study:

  • To review current pharmacotherapy for PBC.
  • To discuss management strategies for PBC-related side effects like pruritus and fatigue.
  • To provide an overview of prognostic tools and advanced care options.

Main Methods:

  • Literature review of available scientific publications.
  • Analysis of current treatment guidelines and clinical trial data.
  • Synthesis of information on pharmacotherapy, side effect management, and prognostication.

Main Results:

  • UDCA is recommended for elevated liver enzymes in PBC patients.
  • Obeticholic acid (OCA) serves as an adjunctive therapy for non-cirrhotic patients with inadequate response to UDCA.
  • Management of pruritus and fatigue requires multifaceted approaches, including lifestyle and pharmacological interventions.

Conclusions:

  • Treatment decisions for PBC should be individualized based on response and disease progression.
  • Prognostic tools like Mayo Risk Score and GLOBE aid in risk stratification.
  • Liver transplantation remains an option for advanced PBC, necessitating timely referral.