Primary biliary cholangitis (PBC)

Primary biliary cholangitis affects the liver, specifically the small and medium bile ducts inside it. The condition is understood to involve a loss of immune tolerance toward mitochondrial proteins in the cells lining these ducts, triggering antibody and T-cell driven damage that slowly destroys the ducts, so bile backs up and, over a long time, can scar the liver. Genetics and environmental exposures are also thought to play contributing roles. It was formerly called primary biliary cirrhosis.

A large 2025 systematic review and meta-analysis, drawing on 59 studies across 25 countries, found that prevalence and incidence vary significantly by region and have been rising over recent decades, likely reflecting both a true increase and greater detection. Primary biliary cholangitis shows a strong female predominance, with a female-to-male ratio estimated around 10 to 1.

Common signs

Fatigue and itching are the most common early experiences, and both can be significant. As the condition progresses, some people notice dry eyes and mouth, discomfort under the right ribs, yellowing of the skin or eyes, darkened skin, or small fatty deposits around the eyes. Many people have no symptoms at all, found only through routine liver blood tests.

This is a plain-language summary for orientation, not a diagnosis. Mechanisms are described as current understanding, not settled fact. Work with your own clinician for your care.