Increased awareness of the condition and the increasing availability of diagnostic tools, in particular serological testing, have led to a more frequent and earlier diagnosis of PBC [25] . More than half of patients diagnosed today with PBC are asymptomatic at presentation [26, 27] . They generally attract attention by findings of elevated serum alkaline phosphatase (AP) and/or total serum cholesterol, especially in asymptomatic patients often during routine checkup. A diagnosis of PBC is made "with confidence" when biochemical markers of cholestasis, particularly alkaline phosphatase, are elevated persistently for more than 6 months in the presence of serum AMA and in the absence of an alternative explanation [28, 29] . In PBC patients, AMA is generally present in high titer. Low-titer AMA may not be specific and may disappear on retesting [30] .