Publication:

Recent advances in diagnosis and management of chronic cholestatic liver diseases: expert consensus

Chronic cholestatic liver diseases (CCLD), primarily including primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), are characterized by impaired bile flow, leading to systemic complications such as pruritus, jaundice, fat soluble vitamin deficiencies and progressive liver damage. Recent advances in diagnostics, particularly the use of non-invasive tests like FIB-4, APRI and transient elastography, have significantly improved the early detection and assessment of liver fibrosis. Ursodeoxycholic acid (UDCA) remains the cornerstone treatment for PBC, effectively improving biochemical markers and delaying disease progression. In contrast, the treatment options for PSC remain limited. Emerging therapies targeting bile acid synthesis and gut microbiota modulation are under investigation, offering potential future solutions for PSC. In the Indian clinical setting, other causes of intrahepatic cholestasis, such as alcoholic liver disease (ALD) and drug-induced liver injury (DILI), are more prevalent. ALD with cholestasis is seen in 10-30% of patients, while DILI, often driven by tuberculosis medications and complementary and alternative medicines, accounts for a significant proportion of cases. Infectious causes like hepatitis A and fibrosing cholestatic hepatitis in hepatitis C patients post-liver transplantation also contribute to the disease burden. Experts recommend ongoing UDCA use in cholestatic conditions, regular non-invasive fibrosis assessments, and further research into new pharmacological agents for both PBC and PSC.