Primary Biliary Cirrhosis Treatment (PBC) (cont.)

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Scleroderma

Skin tightening, calcification, or telangiectasia: There is no known therapy to prevent or reverse skin tightening, calcium deposits, or telangiectasias in patients with scleroderma.

Swallowing problems and heartburn: As previously mentioned, patients with scleroderma may experience heartburn or difficulty swallowing. It is recommended that patients with these symptoms or other evidence of scleroderma or the CREST syndrome:

  • Take drugs called proton pump inhibitors to reduce stomach acid.
  • Avoid eating or drinking within 2 hours of lying down or going to bed.
  • Elevate the head of the bed about 6 to 8 inches. This gentle slope helpsprevent stomach acid from flowing up into the esophagus.
  • Consult a gastroenterologist (a specialist in diseases of the esophagus and stomach) to undergo an upper endoscopy to assess the interior of esophagus and stomach.

Gallstones

Cholesterol gallstones may be prevented by the UDCA used for the long-term treatment of the PBC itself. (UDCA taken orally can actually dissolve cholesterol gallstones in a minority of patients.) No treatment is necessary for patients who have gallstones that are not causing symptoms. These patients should usually just be observed because they will probably never develop symptoms from their gallstones.

An operation (cholecystectomy) to remove the gallbladder and its gallstones should be considered if the gallstones have been causing symptoms. These symptoms ordinarily are bouts of rather characteristic abdominal pain. This surgery usually should not be done, however, if a patient has advanced cirrhosis because of the increased risk of complications from both the surgery and the PBC. In this situation, less risky procedures can be considered or, if the gallstones are the cholesterol type, UDCA (if not already being used to treat the PBC) can be given reasonably safely to try to dissolve the gallstones.

Medically Reviewed by a Doctor on 4/30/2014