Primary Biliary Cirrhosis (PBC) (cont.)

What treatments are used for the complications of the cirrhosis in PBC?

Edema and ascites

Retention of salt and water can lead to swelling of the ankles and legs (edema) or abdomen (ascites) in patients with cirrhosis. Diuretics are medications that work in the kidneys to combat retention of fluid by eliminating salt and water into the urine. A combination of the diuretics spironolactone (Aldactone) and furosemide can reduce or eliminate the swelling in most people. During treatment with diuretics, it is important to monitor kidney function by measuring serum levels of blood urea nitrogen (BUN) and creatinine to determine if the doses of the diuretics are safe. Sometimes, when the diuretics do not work, a long needle is used to draw out the fluid directly from the abdomen (a procedure called paracentesis).

Bleeding from varices

If large varices (distended veins) develop in the esophagus or upper stomach or any episodes of bleeding from varices have occurred, physicians should consider specific therapy for the varices. Treatment with propranolol (Inderal), a drug in a class called beta-blockers, is effective in preventing initial bleeding or rebleeding from varices in patients with cirrhosis. This drug, however, has not been proven to prevent bleeding in patients with portal hypertension who do not have cirrhosis.

Other methods are available to prevent or treat varices. These methods include:

  • Other drugs [for example, octreotide (Sandostatin)]
  • Other non-surgical procedures (for example, a procedure called TIPS to decrease the portal pressure)
  • A surgical operation to create a shunt (passage) from the high-pressure portal vein to veins with lower pressure can eliminate blood flow into the varices. It is appropriate to consider such a surgical shunt for patients with PBC and portal hypertension who do not have cirrhosis or have only early cirrhosis. The hazards of shunt surgery in these patients would be less than those in patients with advanced cirrhosis.


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