[Cholestatic liver disease]

Abstract

Common cholestatic liver diseases are primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). Both diseases are considered autoimmune disorders; however, the precise pathogenesis remains elusive. Patients usually show no symptoms or present with pruritus and fatigue. High alkaline phosphatase and the presence of antimitochondrial antibodies are sufficient to diagnose PBC. Ursodeoxycholic acid is approved and recommended for the treatment of PBC. The diagnosis of PSC is established by elevated alkaline phosphatase-levels and typical cholangiographic findings. Liver biopsy is not generally necessary for the diagnosis. The prevalence of inflammatory bowel disease in PSC is up to 80 %. There is no established pharmacological therapy, although Ursodeoxycholic acid is often prescribed. Endoscopic management of biliary obstructions offers clinical benefit. Liver transplantation is the definitive treatment for patients with advanced or decompensated cirrhosis.