PBC vs PSC?

[AutoimmunetoStars]

Hey, it's been a while! I wanted to know if there's a significant difference between the two when it comes to diagnosing? Recently, I've had symptom flare and my doctor said if the enzymes are elevated again- it's either Antibiotics (Alk phos- PSC) or Steroids (ALT/AST-AIH)

What is the probability for it to be PBC instead? I'm not sure how common this problem is with waiting and see..

[PBCRobert Partner]

Hello.

Yes raised ALT and AST are *indicative* of AIH but are not considered to be diagnostic. To diagnose AIH, a biopsy is usually required.

Alk Phos can be a number of things.

Alk Phos and positive AMA would be diagnostic of PBC.

PSC is diagnosed usually through an MRCP or through ERCP. There are a number of liver tests that are often raised in PSC. Again, they are not diagnostic, more indicative.

With regards to treatments, I am not sure that antibiotics are used to treat PSC. Treatments for each condition are very different, but first things first... get your diagnosis first.

If we can help with any more information, please do get back in touch.

[AutoimmunetoStars in reply to PBCRobert]

Thanks! Doc wanted steriods for raised ALT/AST because it's been a pattern, and I've been biopsied twice. Both shoe inflammation but the cause is unknown- but IGG has been continuously elevated, particularly IGG4. However, because a certain stain was rejected by path, AIH was never fully off the table.

Alk Phos being elevated would be, at least, indicated for PSC I think (at least in their eyes) because I did have Ulcerative Colitis and although it's not on the MRCP, theres a chance of it being involved with the small ducts and the antibiotics would deal with it when it 'clogs' or something. I'm not so knowledgeable on small duct things.

I was wondering what the odds were if it had been PBC, since I do have the antibodies, they aren't elevated however. (False positive) Frankly, I prefer never ever going back on steriods.

[Ballymahon2 in reply to AutoimmunetoStars]

My advice to you would be to get a referral from your primary doctor to see a hepatologist