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Primary biliary cholangitis — RCPSC IM MCQ

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HardGastroenterology/HepatologyPrimary biliary cholangitisRCPSC IM

A patient with primary biliary cholangitis remains biochemically high risk after a year of adherent ursodeoxycholic acid. What is the best next step?

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Correct answer: C — Refer for second-line therapy and transplant-risk assessment

The best answer is “Refer for second-line therapy and transplant-risk assessment”. Incomplete biochemical response identifies higher progression risk and warrants hepatology review for second-line therapy, adherence and transplant-risk stratification while ursodeoxycholic acid generally continues. Symptom treatment alone does not address disease progression. Response criteria, fibrosis stage, biochemical trajectory and symptoms determine the next agent and the timing of transplant-centre involvement.

Reference: Canadian Association for the Study of the Liver: https://hepatology.ca/