Gideon M Hirschfield1, Olivier Chazouillères2, Helena Cortez-Pinto3, Guilherme Macedo4, Victor de Lédinghen5, Femi Adekunle6, Marco Carbone7
1Toronto Centre for Liver Diseases, University Health Network and University of Toronto, Toronto, Canada.
2Assistance Publique - Hôpitaux De Paris (APHP), Reference Centre for Inflammatory Biliary Diseases and Autoimmune Hepatitis (CRMR, MIVB-H), Department of Hepatology Saint-Antoine Hospital, Sorbonne Université, INSERM, Saint-Antoine Research Center, Paris, France.
3Clínica Universitária De Gastrenterologia, Faculdade De Medicina, Universidade De Lisboa, Lisbon, Portugal.
4Gastroenterology and Hepatology Department, Centro Hospitalar São João, Porto, Portugal.
5Hepatology Unit, Bordeaux University Hospital, Pessac, & INSERM U1053, Bordeaux University, Bordeaux, France.
6Intercept Pharmaceuticals, Europe Ltd. London, UK.
7Division of Gastroenterology, Centre for Autoimmune Liver Disease, University of Milan-Bicocca, Milan, Italy.
Introduction: Primary biliary cholangitis (PBC) is an infrequent, immune-mediated cholestatic liver disease, which can lead to liver fibrosis, cirrhosis and complications of end-stage liver disease. The established goals of treatment of PBC are prevention of end-stage liver disease and amelioration of associated symptoms. The European Association for the Study of the Liver (EASL) management guidelines provide extensive recommendations on the diagnosis and management of PBC.
Areas covered: This article describes the development by expert consensus of a 'PBC Integrated Patient Care Pathway' to simplify and standardize the management of PBC for clinicians based on current practice.
Expert opinion: Guideline adoption is potentially poor in practice since most patients with PBC in the community are seen by general gastroenterologists or hepatologists without a special interest in autoimmune liver disease. The PBC Integrated Patient Care Pathway is a best practice tool for clinicians designed to complement the EASL Clinical Practice Guidelines for the diagnosis and management of PBC patients. It gives clinicians a practical decision tree of the key steps in PBC management, thereby providing a simplified framework and an opportunity for more uniform practice that supports the safe and timely adoption of varied models of care provision to patients with PBC.