A recent review of PSC was published (Gastroenterology 2013; 145: 521-36). This review is a little more detailed than a previous review noted in this blog less than 6 months ago (Staying current with PSC | gutsandgrowth).
A couple of useful comments from the review:
- “An increased serum level of alkaline phosphatase is the most common biochemical abnormality detected in patients with PSC. In some cases, it is the only biochemical alteration observed, such as in patients with intrahepatic involvement.”
- “Typically, a liver biopsy is not required to diagnose PSC unless small duct PSC is suspected or if there are concerns that a patient also has AIH.” Cholangiography is the best way to identify PSC.
- “Patients diagnosed with PSC should undergo colonoscopy… to determine if they have IBD, even when there are no symptoms.”
- Autoimmune hepatitis-PSC overlap is thought to occur in ≤6% of cases. AIH-PSC should be suspected if there are biochemical features of AIH (positive serology, increased transaminases), histology suggestive of AIH, or in AIH patients that become refractory to treatment.
- No controlled trials have identified effective medical treatments. Studied medications have included corticosteroids, etanercept, tacrolimus, cyclosporine, azathioprine, methotrexate, infliximab, and ursodeoxycholic acid. The latter may increase disease progression, particularly at higher doses.
Hepatology 2013; 58: 1392-1400. “Primary Sclerosing Cholangitis, Autoimmune Hepatitis, and Overlap in Utah Children: Epidemiology and Natural History”
In this study the authors identified 607 cases of IBD, 29 cases of PSC, 12 cases of ASC (overlap), and 44 cases of AIH. “Cholangiocarcinoma developed in 2 of the 29 PSC patients (6.9%). PSC occurred in 9.9% of patients with ulcerative colitis (UC) and 0.6% of patients with Crohn’s disease.”
Related blog posts:
- Colonic disease and PSC | gutsandgrowth
- Challenges with primary sclerosing cholangitis | gutsandgrowth Numerous references with this blog post.
- Screening for subclinical PSC in IBD? | gutsandgrowth
- Diagnosing autoimmune hepatitis | gutsandgrowth
- Azathioprine metabolite measurement for Autoimmune Hepatitis …
Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) and specific medical management interventions should be confirmed by prescribing physician. Application of the information in a particular situation remains the professional responsibility of the practitioner.