Triggers and Risk Factors of PBC

Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: David, how would you describe triggers and risk factors for PBC [primary biliary cholangitis]? How do you evaluate that in your practice, and what do you focus on, in terms of taking a history?

David Victor III, MD: One of the things we’ve talked about, in taking the history, are these subtle signs that you have to ask about. I tell our medical students they have to ask close-ended questions. “Do you have itching? How long has it been? How long have you been having insomnia?” And listing the signs and symptoms of the manifestations of disease. I typically find that there’s a lot of education that patients being diagnosed need to understand, including defining what cirrhosis is and what primary biliary cholangitis is. Also, talking to them about the trajectory of disease, from how long it typically takes, how long it takes to be diagnosed, and why they are in my office.

Lastly, many of my patients get frustrated that they have an autoimmune disease, and they have to understand that this isn’t something they typically did. They’ll read that they used the wrong nail polish, or that they had a UTI [urinary tract infection] that led them here. It’s not their fault that they have primary biliary cholangitis. It is just somewhat bad luck, and I think helping them to understand that is one of the more important things. Especially since we’re asking for a long-term commitment from our patients for therapy, as well as to accept a diagnosis that seems somewhat unfair. So, I think patients need education about the disease itself and a better understanding of what exactly it is, from an autoimmune standpoint.

Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: That’s a great summary that’s kind of approachable. The way I like to think about it is, I explain to the patient, you have a genetic predisposition to this condition, because of your autoimmune diathesis, if you will. Then, there could be one or more environmental triggers.

Transcript edited for clarity