First a bit about how the US and UK differ:
US - we have PCP (Primary Care Physicians). UK - GPs.
US - normally, a PCP catches something suspicious in your blood work and refers you to a specialist. In the US, you must be 'board certified' to call yourself a specialist. Currently, you can be board certified in Internal Medicine and board certified in Gastroenterology which is a sub-specialty of Internal Medicine. Hepatology is considered a sub-specialty of Gastroenterology. So this means, in the US, we see a Gastro (gastroenterologist), who has received special training in hepatology, but we have no "Hepatologists" per se as you do in the UK.
US - we don't go to hospital or clinic or consult. We have Specialists as opposed to Consultants. Our PCP refers us to a Gastro with the appropriate training in hepatology (hopefully, but not certain. The doctor must be on your insurance company's provider list unless you want to pay, and the more rural you are the less doctors and less specialists and less sub-specialists). US specialists usually have their own practice/office, just like our PCPs. I live in a medium-sized town in Ohio and I see a gastroenterologist who has had special training in hepatology. If I lived nearer a major city or a city with a major university near it, I could go to an actual Liver Center staffed with tons of specialists, but only if it were in my provider list or I become fabulously wealthy and paid cash.
Sadly, in the US, our LFTs are only abnormal or elevated. I think that having 'deranged' LFTs is charming.
No, it is not common practice to have a liver biopsy done if you are early stage PBC and asymptomatic. I saw two Gastros. The first Gastro, twice in 2013, who gave me the baseline LFTs and the diagnosis. With the start of 2014, my insurance company's provider list changed so my Gastro changed also. Neither Gastro wanted me to have a biopsy because it is an invasive procedure which always has risks and - as Peridot (who I find has the most consistent, relevant and current knowledge/input/posts about PBC. And she so kindly takes the time to reply to so many posts) says - a liver biopsy just gives you a tiny glimpse of what's going on in your liver. Having a biopsy in the early stages of PBC, they may get a sample from a 'bad' area or a 'good' area.
I am also on this one with Peridot. I don't want to be 'staged' and labelled. Since there's so little one can do about PBC, I prefer willful ignorance. I take my ursodeoxycholic acid (US - ursodiol; UK - urso. Except we tend to shorten it to urso, too). Am asymtomatic and believe I will die with the disease, not from it. If I had a biopsy and was told I was stage 3 - or worse 4 - just because they got a 'bad' sample, I'd worry and fret myself to death.
I also have hypothyroidism so I see my PCP every 6 months for a blood draw. He will now also be doing my LFTs and forwarding them on to my gastro. I will see my gastro annually (unless those pesky LFT's go screwy or I turn yellow).
I have read and read and read and read and read. My PCP will tell you gladly admit to you if you ask that I know more about PBC than he does. I am careful to extract my information from peer-reviewed professional journals while checking the date and the authors to make certain I am reading the most current and best information available. Before the introduction of ursodeoxycholic acid (UDCA), the life expectancy upon diagnosis of PBC was 4 + something years! Online websites often have this dated information and other misinformation about PBC.
Sorry for the length.
Sorry for coming off as a know-it-all if it seemed so to you - I blame all that reading :).
Glad to meet everyone.
Hope you all have a lovely holiday.