Current concepts in primary biliary cirrhosis and primary sclerosing cholangitis

Seth N. Sclair, Ester Little, Cynthia Levy

Research output: Contribution to journalReview article

13 Scopus citations

Abstract

Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are chronic, cholestatic diseases of the liver with common clinical manifestations. Early diagnosis and treatment of PBC slows progression and decreases the need for transplant. However, one-third of patients will progress regardless of treatment. Bilirubin <1.0 and alkaline phosphatase <2.0 x the upper limit of normal at 1 year after treatment appear to predict 10-year survival. Ursodeoxycholic acid (UDCA) is the recommended treatment for PBC, and recent studies with obeticholic acid showed promising results for UDCA non-responders. Unlike PBC, no therapy has been shown to alter the natural history of PSC. The recommended initial diagnostic test for PSC is magnetic resonance cholangiopancreatography, typically showing bile duct wall thickening, focal bile duct dilatation, and saccular dilatation of the intra- and/or extrahepatic bile ducts. Immunoglobulin 4-associated cholangitis must be excluded when considering the diagnosis of PSC, to allow for proper treatment, and monitoring of disease progression. In addition to the lack of therapy, PSC is a premalignant condition and close surveillance is indicated.

Original languageEnglish (US)
Article numbere109
JournalClinical and Translational Gastroenterology
Volume6
Issue number8
DOIs
StatePublished - Aug 27 2015

ASJC Scopus subject areas

  • Gastroenterology

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