Ace the 2025 ROSH GI Challenge – Master the Gut and Own the Exam!

The primary symptom that suggests the presence of primary biliary cholangitis is pruritus, which is characterized by intense itching. This symptom occurs due to the accumulation of bile acids in the bloodstream, a hallmark of cholestasis, which is often the result of the progressive destruction of the small bile ducts seen in this condition. Patients may describe the itching as particularly bothersome at night and can affect their quality of life significantly.

While fatigue, jaundice, and abdominal pain can also be associated with liver disease, they are not as specific to primary biliary cholangitis. Fatigue is a common and nonspecific symptom in many chronic diseases, including liver conditions, but it does not uniquely point to this disorder. Jaundice typically appears later in the disease process as bile flow becomes more severely obstructed, and abdominal pain is less commonly reported when compared to pruritus in patients with primary biliary cholangitis. Therefore, the distinctive and early presentation of pruritus is the key symptom that raises suspicion for this particular disease.