Screening for subclinical PSC in IBD?

In children with IBD, elevated liver enzymes raise the concern for primary sclerosing cholangitis (PSC).  PSC is thought to develop in up to 5% of patients with IBD.  To look more closely at this issue, a group of investigators examined 73 children (median age 12 years) with IBD with MRCP to look for evidence of PSC (JPGN 2012; 55: 308-13).

The majority of these patients had an MRCP at the time of an MRE; this was ordered independently from specific laboratory or clinical factors.  On average, the date for MRCP was about one year after the date of diagnosis.  In this group, 49 (67%) had Crohn’s disease (CD), 19 (26%) had indeterminate colitis (IC), and 5 (6.8%) had ulcerative colitis (UC) [In the results section, the authors state a discrepancy from previous: 47 with CD, 18 with IC, and 8 with UC.]

11 (15%) children had PSC-type lesions identified by MRCP.  6 of these patients had CD, 3 had IC, and 2 had UC.  Among the PSC group, 5 had abnormal AST & ALT, 4 had abnormal GGT, and 1 had abnormal bilirubin at time of diagnosis & similar numbers were present at the time of MRCP.  A much lower percentage of the non-PSC group (n=62), had abnormal LFTs.  Though, at time of MRCP, 9 (14.5%) had abnormal ALT.

An editorial in the same issue (page 238), concludes that “screening for PSC by MRCP in all of the newly diagnosed patients with IBD seems promising.”  Really?  Given a lack of therapeutic options, I don’t think identifying preclinical PSC makes any sense.  An exception would be in patients with persistent liver test abnormalities to avoid attributing this to medication toxicity.


Challenges with primary sclerosing cholangitis | gutsandgrowth

Colonic disease and PSC | gutsandgrowth

Additional reference:

-Hepatology 2009; 50: 808-14.  High-dose ursodeoxycholic acid not effective for PSC (worsened outcomes noted)