Role of ductular reaction and ductular–canalicular junctions in identifying severe primary biliary cholangitis

•Ductular reaction is a histological hallmark of severe disease in people with PBC.•Prominent ductular reaction is associated with an inadequate response to UDCA therapy.•Ductular reaction is implied in maintaining ductular–canalicular junction integrity.•Ductular reaction is implied in fibrogenesis in people with PBC.•In murine cholestasis, UDCA improves ductular–canalicular junctions and fibrosis.