Up to One in Four Patients With PBC May Already Have Cirrhosis at Diagnosis: Advance GastroHep | August 2026

Introduction:

Primary biliary cholangitis (PBC) is a progressive cholestatic liver disease in which early diagnosis and treatment can prevent progression to cirrhosis. However, many patients remain asymptomatic and undiagnosed for years. This large U.S. Veterans Affairs study evaluated the real-world prevalence of PBC and, importantly, how frequently patients already had cirrhosis when PBC was first diagnosed.

Why was this study needed?

Up to half of individuals with PBC may remain undiagnosed.

Many patients are asymptomatic, contributing to delayed recognition.

The true prevalence of PBC in the United States remains uncertain.

Delayed diagnosis may allow preventable progression to advanced liver disease.

Results:

Among >5.1 million U.S. veterans, estimated PBC prevalence ranged from 19.5–76.2 per 100,000, depending on diagnostic criteria.

PBC was more prevalent among women, individuals ≥60 years, and Hispanic and Asian/Pacific Islander populations.

Most importantly, 11–26% of patients already had cirrhosis at PBC diagnosis, with advanced disease generally more frequent in men.

Clinical Impact:

The finding that up to one-quarter of patients may have cirrhosis when PBC is first recognized highlights a major diagnostic gap. Greater awareness of unexplained cholestatic liver tests and timely antimitochondrial antibody (AMA) testing could facilitate earlier diagnosis and treatment before irreversible liver damage develops.

Bottom Line:

PBC remains substantially under-recognized, with up to one in four patients already having cirrhosis at diagnosis. Earlier investigation of persistent cholestatic liver abnormalities and appropriate AMA testing may identify PBC before progression to advanced liver disease.