Drug therapy of primary biliary diseases: classical and modern strategies.

Definition: Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are both cholestatic liver diseases. A common feature of these disorders is the accumulation of bile acids in the liver and blood, presumably because of decreased biliary secretion and reduced bile flow. Etiology: Etiology and pathogenesis of PBC and PSC are still unknown. PBC is considered to be an autoimmune disease [1]. Immunological mechanisms may also be involved in PSC since there is an association with ulcerative colitis [2] and autoantibodies can be detected [3]. Furthermore, genetic factors seem to play an important role in both diseases [3,4]. Therapy: Since the pathogenesis of both diseases is unclear, there is no definite causal treatment. However, ursodeoxycholic acid (UDCA) was shown to be highly effective. Other drugs which can be used alone or in combination with UDCA are promising and might further improve the outcome of the diseases.