{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:25:15Z","timestamp":1784543115492,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Primary Biliary Cholangitis (PBC) is a chronic autoimmune liver disease characterised by bile duct destruction, leading to cholestasis and fibrosis. Despite therapeutic advancements, gaps remain in diagnostic standardisation, treatment response evaluation, and patient\u2010centred care. This study aimed to develop consensus\u2010driven quality measures to optimise PBC management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the Delphi methodology, 92 clinicians participated in two rounds of surveys addressing diagnostic protocols, therapeutic strategies, follow\u2010up standards, and patient\u2010reported outcomes (PROs). Appropriateness ratings were analysed using the RAND\/UCLA method to achieve consensus on key quality measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Strong consensus was reached on the appropriateness of non\u2010invasive diagnostic tools such as Vibration\u2010Controlled Transient Elastography (VCTE) and abdominal ultrasound for staging and monitoring fibrosis in chronic cholestasis. Different treatment options were evaluated in patients with inadequate response to UDCA, including compensated cirrhosis (Child\u2010Pugh A), with early initiation deemed appropriate in cases of UDCA intolerance or partial response. Genetic studies and liver biopsy showed variability in consensus, particularly for patients without biochemical cholestasis, reflecting areas needing further research.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study establishes actionable quality measures for PBC care, offering specific recommendations on diagnostic protocols, therapeutic benchmarks, and follow\u2010up standards. These measures go beyond guidelines by addressing gaps in patient stratification, follow\u2010up protocols, and strategies. Future research should address cost\u2010effectiveness, access to non\u2010invasive tools, and implementation challenges such as clinician training and resource availability.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.70118","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T12:54:29Z","timestamp":1746190469000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Quality Measures to Enhance the Management and Treatment of Primary Biliary Cholangitis: A Delphi Consensus Study"],"prefix":"10.1111","volume":"45","author":[{"given":"Domenico","family":"Alvaro","sequence":"first","affiliation":[{"name":"Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0287-1059","authenticated-orcid":false,"given":"Vincenza","family":"Calvaruso","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Section of Gastroenterology and Hepatology University of Palermo  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1445-0443","authenticated-orcid":false,"given":"Marco","family":"Carbone","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, Gastroenterology University of Milano\u2010Bicocca  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6937-8664","authenticated-orcid":false,"given":"Nora","family":"Cazzagon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology University of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annarosa","family":"Floreani","sequence":"additional","affiliation":[{"name":"University of Padua  Padua Italy"},{"name":"Scientific Consultant of IRCSS (Scientific Institute for Research, Hospitalization and Healthcare)  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3262-1998","authenticated-orcid":false,"given":"Pietro","family":"Invernizzi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Centre for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) IRCCS Fondazione San Gerardo Dei Tintori  Monza Italy"},{"name":"Department of Medicine and Surgery University of Milano\u2010Bicocca  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Marzioni","sequence":"additional","affiliation":[{"name":"Clinic of Gastroenterology AOU Ospedali Riuniti, Polytechnic University of Marche  Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5560-1979","authenticated-orcid":false,"given":"Patrizio","family":"Pasqualetti","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Section of Health Statistics and Biometry Faculty of Pharmacy and Medicine, Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Pennisi","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Section of Gastroenterology and Hepatology University of Palermo  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2566-3041","authenticated-orcid":false,"given":"Pierluigi","family":"Toniutto","sequence":"additional","affiliation":[{"name":"Hepatology and Liver Transplant Unit University 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