Long-term Treatment of Primary Sclerosing Cholangitis in Children With Oral Vancomycin: An Immunomodulating Antibiotic

@article{Davies2008LongtermTO,
  title={Long-term Treatment of Primary Sclerosing Cholangitis in Children With Oral Vancomycin: An Immunomodulating Antibiotic},
  author={Yinka K. Davies and Kathleen M Cox and Bisher A Abdullah and Anca M. Safta and Annie B Terry and Kenneth L. Cox},
  journal={Journal of Pediatric Gastroenterology and Nutrition},
  year={2008},
  volume={47},
  pages={61–67}
}
Background: Primary sclerosing cholangitis is a rare chronic cholestatic condition of unknown etiology, frequently associated with inflammatory bowel disease and characterized by diffuse fibrosing and inflammatory destruction of the intra- and/or extrahepatic biliary duct system. Patients and Methods: The study involved 14 children with primary sclerosing cholangitis confirmed by either liver biopsy, endoscopic retrograde cholangiopancreatography, and/or magnetic resonance cholangiogram. In… 

Treatment of primary sclerosing cholangitis in children

The evidence for drug efficacy, dosing, duration of therapy, and treatment targets in PSC is reviewed, and a framework for endoscopic and medical management of this complex problem is provided.

Current Management of Primary Sclerosing Cholangitis in Pediatric Patients

Treatment of PSC is mainly supportive and directed at controlling cholestatic symptoms and preventing complications, and Ursodeoxycholic acid is helpful in inducing biochemical improvement; long-term pediatric studies to determine a benefit of this agent in young patients are lacking, although results from adult studies have not been promising.

Sclerosing Cholangitis: Pediatric Perspective

Orthotopic liver transplantation remains the only life-extending alternative for patients with sclerosing cholangitis, with good long-term patient and graft survival, and recurrent graft primary scleroses cholangsitis in about 10% of children.

Pediatric Primary Sclerosing Cholangitis

There is no known therapy to prevent progression of primary sclerosing cholangitis; however further research on the effectiveness of ursodeoxycholic acid and oral vancomycin therapies is warranted.

Primary sclerosing cholangitis: Unique aspects of disease in children

Primary sclerosing cholangitis (PSC) is a rare disorder of the hepatobiliary system characterized by a chronic diffuse inflammation and obliterative fibrosis of the intrahepatic and/or extrahepatic

An Overview on Primary Sclerosing Cholangitis

Continuous screening consists of annual clinical, biochemical, and ultrasound assessments in asymptomatic patients and annual colonoscopy in patients with PSC and inflammatory bowel disease and further studies are in progress to establish the effect of molecular-targeted therapies in PSC.

Successful response of primary sclerosing cholangitis and associated ulcerative colitis to oral vancomycin may depend on brand and personalized dose: report in an adolescent

Evidence suggests that oral vancomycin both alters the intestinal microbiome and has immunomodulatory effects and its striking effectiveness in this and other patients supports further investigation in randomized trials, with careful attention to its bioavailability profile in the gut.

Use of oral vancomycin in children with autoimmune liver disease: A single centre experience

Preliminary results suggest that a prospective study is indicated to define the efficacy of OVT in AILD, and that OVT may represent a valuable treatment option to achieve biochemical remission in patients not responding to standard IS.
...

References

SHOWING 1-10 OF 28 REFERENCES

Primary sclerosing cholangitis in childhood.

Immunogenetic aspects of primary sclerosing cholangitis: implications for therapeutic strategies.

Support is presented for drug therapy with ursodeoxycholic acid in the treatment of primary sclerosing cholangitis and the genetic and immunological factors in the pathogenesis of PSC are outlined first.

Bile duct bacterial isolates in primary sclerosing cholangitis: a study of explanted livers.

Etiology and natural history of primary sclerosing cholangitis.

The development of a multivariate statistical survival model from long-term survival data from the Mayo Clinic and other centers has been a major step in identifying individual primary sclerosing cholangitis patients at low, moderate, and high risk of dying.

Case Report: Three paediatric cases of primary sclerosing cholangitis treated with ursodeoxycholic acid and sulphasalazine

It is suggested that sulphasalazine in addition to UDCA might be a viable treatment for children with primary sclerosing cholangitis.

Serum autoantibodies, ulcerative colitis and primary sclerosing cholangitis.

Sera from eight of 15 patients with primary sclerosing cholangitis, ulcerative colitis and anticolon antibody reacted with portal tracts of human obstructed liver, indicating a close relationship between HLA-B8 phenotype and the portal tract antibody.

Ursodiol for Primary Sclerosing Cholangitis

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.

Serum autoantibodies in patients with primary sclerosing cholangitis.

[Primary sclerosing cholangitis].

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.