FAQ: What is The Difference Between PBC and PSC

Maly Tiev, a hepatology nurse practitioner at NYU Langone Health in New York, discusses the key differences between primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). She reviews differences in bile duct involvement, patient populations, underlying disease mechanisms, and associated conditions, including the relationship between PSC and inflammatory bowel disease (IBD). The discussion explores diagnostic approaches, including antimitochondrial antibody (AMA) testing, alkaline phosphatase (ALP) levels, and magnetic resonance cholangiopancreatography (MRCP), along with shared symptoms such as fatigue and pruritus. Maly also compares PBC treatment with ursodeoxycholic acid (UDCA) and consideration of second-line therapy with PSC management focused on symptom relief, bile duct strictures, and surveillance for complications. She highlights the importance of understanding PSC-associated cancer risks, including cholangiocarcinoma, gallbladder cancer, and colorectal cancer in patients with coexisting IBD. Designed for nurse practitioners, physician assistants, and other healthcare professionals caring for patients with cholestatic liver disease, this video offers a practical comparison of PBC and PSC to support diagnostic evaluation, treatment decisions, and long-term patient monitoring.