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
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
- Other drugs [for example, octreotide
- Other non-surgical procedures (for example, a procedure called TIPS to decrease the portal
- 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.