ACG Clinical Guideline: Primary Sclerosing Cholangitis

@article{Lindor2015ACGCG,
  title={ACG Clinical Guideline: Primary Sclerosing Cholangitis},
  author={Keith D. Lindor and Kris V. Kowdley and M Edwyn Harrison},
  journal={The American Journal of Gastroenterology},
  year={2015},
  volume={110},
  pages={646-659}
}
Primary sclerosing cholangitis is a chronic cholestatic liver disease that can shorten life and may require liver transplantation. The cause is unknown, although it is commonly associated with colitis. There is no approved or proven therapy, although ursodeoxycholic acid is used by many on an empiric basis. Complications including portal hypertension, fat-soluble vitamin deficiency, metabolic bone diseases, and development of cancers of the bile duct or colon can occur. 
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338 Citations
Highly Influential Citations
22
Background Citations
55
Methods Citations
14
Results Citations
1

338 Citations

Primary Sclerosing Cholangitis: What the Gastroenterologist and Hepatologist Needs to Know.
Primary Sclerosing Cholangitis
TLDR
Management should be treatment of symptoms and complications of cholestasis, as well as attempts at treating the underlying disease process, and efforts should be made to recognize and treat or prevent the known complications of primary sclerosing cholangitis.
Primary sclerosing cholangitis: diagnostic and management challenges
TLDR
The diagnostic and management challenges of PSC are addressed, with a succinct analysis of existing therapies, their limitations, and a glimpse into the future of the management of this multifaceted pathologic entity.
Primary Sclerosing Cholangitis: Therapeutic Options and Surveillance Management
TLDR
An overview of primary sclerosing cholangitis is provided with further focus on current therapeutic options and guidance on surveillance management.
Primary sclerosing cholangitis - a comprehensive review.
Endoscopic Evaluation and Management of Primary Sclerosing Cholangitis
TLDR
The central role of endoscopy in the initial diagnosis of PSC, endoscopic evaluation and endotherapy for dominant strictures, endoscope evaluation for development of CCA, and endoscopic evaluated and management of recurrent PSC after liver transplantation are reviewed.
Primary sclerosing cholangitis and inflammatory bowel disease: Intestine-liver interrelation.
Biliary endoscopy in the management of primary sclerosing cholangitis and its complications
Primary sclerosing cholangitis and inflammatory bowel disease: Intestine–liver interrelation
Primary Biliary Cholangitis and Primary Sclerosing Cholangitis.
TLDR
This review will address the general clinical features of primary biliary cholangitis and primary sclerosing cholangsitis, analyze their commonalities and differences, and provide a state-of-the art overview of the currently available therapeutics.
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References

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TLDR
During treatment with UDCA stenoses of major ducts may develop and early endoscopic dilatation is highly effective and in patients with endstage disease, UDCA is not effective and liver transplantation is indicated.
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TLDR
Novel insights are described into the pathogenesis and management of pruritus in patients with cholestasis and several mediators possibly playing an important role.
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TLDR
The majority of trials using UDCA in PSC are underpowered and fail to show improvements in clinically relevant endpoints, such as delayed progression to cirrhosis, portal hypertension, liver transplantation, development of cholangiocarcinoma, or death.
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TLDR
The primary medical treatment in PBC should focus on reducing the rate of disease progression, and ursodeoxycholic acid has been extensively evaluated and proven to improve liver biochemistries and survival in patients with PBC.
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TLDR
Ursodiol (ursodeoxycholic acid) benefits patients with primary biliary cirrhosis, another cholestatic liver disease, and well-documented primary sclerosing cholangitis in a randomized, double-blind study comparing ursodiol with placebo.
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  • Medicine
    The New England journal of medicine
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TLDR
In a group of patients with well-defined primary sclerosing cholangitis, ursodiol provided no clinical benefit and was associated with improvement in serum alkaline phosphatase, aspartate aminotransferase, bilirubin, and albumin levels at one and two years.
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TLDR
This work has reviewed the current literature on epidemiology, pathogenesis, treatment and the possible influence of rejection on the risk of recurrent disease in the allograft affecting primary sclerosing cholangitis patients.
Primary sclerosing cholangitis
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Background: Results from a pilot investigation with tacrolimus for primary sclerosing cholangitis (PSC) demonstrated biochemical improvement without excessive drug toxicity. To date, no confirmatory…
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