New PBC Consensus Makes Liver Stiffness Central to Follow-up: ÖGGH | September 2026

Introduction:

PBC management is moving beyond simply starting UDCA and assessing response after one year. The new Austrian consensus emphasizes earlier biochemical assessment, more ambitious treatment targets, second-line therapy, and VCTE-based risk stratification.

Why was this consensus needed?

Inadequate UDCA response predicts disease progression.

Waiting 12 months may delay escalation in higher-risk patients.

New PPAR agonists have expanded second-line treatment options.

Non-invasive fibrosis assessment can improve long-term risk stratification.

Key Takeaways:

UDCA 13–15 mg/kg/day remains first-line therapy for all patients.

In higher-risk patients, biochemical response may be assessed as early as 6 months.

The emerging treatment target is normal ALP with low-normal bilirubin.

Inadequate responders should be considered for seladelpar or elafibranor, with bezafibrate an off-label option.

LSM >10 kPa identifies cACLD and increased decompensation risk.

Higher-risk patients should generally undergo annual VCTE.

Lower-risk complete responders can usually be reassessed every 2–3 years.

HCC surveillance every 6 months remains mandatory in cirrhosis and may be considered with LSM ≥10 kPa or inadequate biochemical response.

What’s New?

PBC care shifts toward earlier treatment escalation and dynamic VCTE-based monitoring, rather than waiting routinely for 12-month biochemical assessment.

Bottom Line:

Treat PBC earlier and aim higher: assess high-risk patients by 6 months, escalate inadequate UDCA responders, and use liver stiffness to guide long-term surveillance.