Which statement best differentiates primary biliary cholangitis from primary sclerosing cholangitis?

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The key difference lies in who is affected, the serology, and the ducts involved on imaging. Primary biliary cholangitis classically occurs in middle-aged women and is associated with antimitochondrial antibodies, causing cholestasis due to destruction of small intrahepatic bile ducts (often with a normal cholangiogram because the disease targets tiny ducts). Primary sclerosing cholangitis, on the other hand, typically affects men, often with inflammatory bowel disease, and is associated with p-ANCA positivity; its hallmark on cholangiography is beading from multifocal strictures and dilations of larger intrahepatic and sometimes extrahepatic ducts. Thus, describing PBC as middle-aged women with AMA and small-duct cholestasis, and PSC as men with p-ANCA and beading on imaging, best captures the distinguishing features.