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Clin Liver Dis. 2018 Aug;22(3):533-544. doi: 10.1016/j.cld.2018.03.014. Epub 2018 May 28.

Chronic Complications of Cholestasis: Evaluation and Management.

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Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT 06510, USA. Electronic address:


Patients with primary biliary cholangitis (PBC) are at risk for various harmful consequences of chronic cholestasis. These include fat-soluble vitamin deficiency, even in the setting of macronutrient sufficiency, as well as metabolic bone disease, including osteoporosis with fractures. Hyperlipidemia is often present and less commonly associated with risk of cardiovascular event; however, the long-term effect of new emerging therapies for PBC remains to be determined. Patients with PBC also have infrequent but notable risk of portal hypertension despite early-stage disease. This review discusses the background, evaluation, and practical management of these complications of chronic cholestasis.


Cholestasis; Fat-soluble vitamin deficiency; Hepatocellular carcinoma; Hyperlipidemia; Malabsorption; Metabolic bone disease; Portal hypertension; Primary biliary cholangitis

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