Complications and Comorbidities

Many people with primary biliary cholangitis (PBC) have other health conditions, including other autoimmune conditions. PBC can also lead to more serious health problems.^1,2

Having another health condition can affect PBC outcomes. This article covers common complications and comorbidities of PBC. Talk to your doctor about your risk for other health problems.

What are comorbidities and complications?

Complications and comorbidities are health conditions that happen at the same time as another condition. They have slight differences:

• Comorbidity – a condition that exists at the same time as another condition
• Complication – a condition that develops because of an existing condition or treatment

For example, other autoimmune conditions are comorbidities of PBC. They often exist at the same time and share risk factors. But one does not directly cause the other. But PBC can cause liver scarring (cirrhosis). So cirrhosis is a complication of PBC. ^1,2

What are the comorbidities of primary biliary cholangitis?

People with PBC often have other autoimmune conditions. This is because of similar risk factors. Some people have a higher genetic risk for an overactive immune system. Environmental factors may then trigger multiple autoimmune conditions.^2,3

Common autoimmune conditions that affect people with PBC can include:2,3

• Sjogren’s syndrome – affects the tear and salivary glands. About 40 percent of people with PBC have symptoms of Sjogren’s syndrome.
• Hashimoto’s thyroiditis and Graves’ disease – these affect the thyroid gland. About 15 percent of people with PBC have autoimmune thyroid disease.
• Systemic sclerosis – affects skin, joints, and other organs. About 15 percent of people with PBC have systemic sclerosis.
• Rheumatoid arthritis – affects joints and other organs. About 10 percent of people with PBC have rheumatoid arthritis.
• Osteoporosis – having weak and brittle bones

What are the complications of primary biliary cholangitis?

As PBC progresses, liver damage worsens. This can lead to serious health problems. Complications of PBC can include:^1,4

• Cirrhosis – liver scarring, which can lead to liver failure and other conditions
• Enlarged veins (varices) – blood backing up into veins in the stomach and esophagus, which can cause internal bleeding. (This is a complication of cirrhosis, rather than PBC directly.)
• Enlarged spleen – swelling caused by the liver not filtering toxins out of the blood (a complication of cirrhosis, rather than PBC directly)
• Gallstones and bile duct stones – hardened stones when bile cannot flow through the ducts (a complication of cirrhosis, rather than PBC directly)
• Liver cancer – Constant inflammation and scarring damage DNA. As the liver tries to heal itself, these genetic errors cause cells to grow uncontrollably and can form tumors. (A complication of cirrhosis, rather than PBC directly)
• Mental and personality changes – brain problems caused by the buildup of toxins (a complication of cirrhosis, rather than PBC directly)
• High cholesterol – which can cause an increased risk of heart attack or stroke (a complication of cirrhosis, rather than PBC directly)
• Vitamin deficiencies – difficulty absorbing fats and vitamins

These are not all the possible complications of PBC. Your doctor may monitor you for signs and symptoms of these complications. Medicines that treat PBC can delay or prevent many of them.

How do other conditions affect PBC outcomes?

Other autoimmune conditions increase the risk of worse PBC outcomes. For example, Sjogren’s syndrome reduces life expectancy for people with PBC. Treating comorbidities is important to manage PBC.³

Complications of PBC usually happen when the condition has advanced. People with PBC who have cirrhosis have worse health outcomes. Cirrhosis can lead to many of the complications listed above, as well as liver failure and other life-threatening problems.^1,2

How are complications of PBC treated?

Treatments for complications will not treat PBC itself. But they can improve symptoms and overall health. Treatment depends on your specific complications. Talk to your doctor about your specific situation. They may recommend:^1,4

• Medicines to lower cholesterol, such as statins
• Vitamins and supplements to improve bone strength
• Diet changes to manage blood pressure and other complications
• Medicines to drain fluid from your abdomen, such as diuretics
• Liver transplant to replace a scarred liver with a healthy one