PBC is suspected in middle-aged women with classic symptoms (eg, unexplained pruritus, fatigue, right upper quadrant discomfort, jaundice) or laboratory results suggesting cholestatic liver disease: elevated alkaline phosphatase (usually higher than 1.5 times the normal range) and GGT but minimally abnormal aminotransferases (alanine aminotransferase [ALT], aspartate aminotransferase [AST], usually less than 5 times normal ranges).