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Primary Biliary Cholangitis — RACP Adult Medicine MCQ

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EasyGastroenterology & HepatologyPrimary Biliary CholangitisRACP Adult Medicine

A 38-year-old woman presents with fatigue, pruritus, and elevated alkaline phosphatase (ALP 450 U/L) with normal bilirubin. Anti-mitochondrial antibodies (AMA) are positive at 1:640. Liver biopsy shows florid duct lesions with granulomatous destruction of bile ducts. What is the first-line treatment?

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Correct answer: D — Ursodeoxycholic acid (UDCA) 13–15 mg/kg/day

This presentation is classic for primary biliary cholangitis (PBC – formerly primary biliary cirrhosis). AMA positivity (especially M2 subtype) is highly specific. First-line treatment is UDCA at 13–15 mg/kg/day, which improves biochemistry, delays histological progression, and improves transplant-free survival. Obeticholic acid is second-line for inadequate response to UDCA.

Reference: eTG – 2025 – Gastrointestinal; AASLD – 2019 – PBC Practice Guidance