Primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC) are both rare diseases that affect the liver’s bile ducts. Though they have similar names and some common characteristics, they’re not the same disease. Here’s a closer look at the similarities and differences of PBC and PSC.
What is primary sclerosing cholangitis?
PSC is a rare and progressive chronic liver disease. Though it can affect people of any age, it’s found mostly in men between ages 30 and 50. It attacks the larger bile ducts inside and outside of the liver, causing inflammation and swelling (cholangitis) that leads to scaring. This build up of scar tissue causes the bile ducts to narrow, which blocks the flow of bile, resulting in liver damage and ultimately, liver failure.
There is currently no cure for PSC. While lifestyle modifications and some medications can help manage symptoms, they don’t slow disease progression. The only effective treatment for PSC is a liver transplant.
What are the similarities between PSC and PBC?
Both PSC and PBC are rare, progressive autoimmune diseases that cause bile ducts to become inflamed and block the flow of bile. In both cases, as the disease progresses the liver becomes damaged, leading to liver failure. Their diagnosis often occurs by accident when a routine blood test or imaging shows liver abnormalities. The exact causes of these two diseases are still unclear; however, neither is caused by drinking alcohol
Shared symptoms include fatigue, itchy skin, jaundice and stomach bloating or pain. In both conditions, changes to lifestyle and diet can help manage these symptoms.
What are the differences?
Despite these similarities, there’s key differences between PSC and PBC:
| PBC | PSC | |
| What bile ducts are affected? | Small bile ducts inside the liver | Medium and large bile ducts inside and outside the liver |
| What is the prevalence? | 18.1 cases per 100,000 people | 13.53 cases per 100,000 people |
| Who is usually diagnosed? | Mainly women age 40-60 | More often men age 30-50, but diagnosis can be at any age |
| What are the treatment options? | Medications to manage symptoms and slow disease progression | No effective options to manage symptoms or slow progression |
| Is there a cancer risk? | No risk | Risk of gall bladder cancer, liver cancer, bile duct cancer and colorectal cancer |
PBC overwhelming affects women: Older research indicated only one in 10 people with PBC were men, though newer research suggests that ratio is now closer to one in six. In comparison, PSC’s gender split is much closer: About six in 10 patients are men.
A diagnosis of PSC usually involves high-definition images of the bile ducts. A diagnosis of PBC, on the other hand, is confirmed through blood tests and a liver biopsy.
PSC is strongly tied to inflammatory bowel disease (which affects about 60% to 80% of patients), especially ulcerative colitis. PBC doesn’t share this connection.
Read more about PBC signs and symptoms
In short, while PBC and PSC may sound similar, they’re unique diseases with different implications for your health and treatment.
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