Primary sclerosing cholangitis: Diagnosis and management

@article{Charatcharoenwitthaya2006PrimarySC,
  title={Primary sclerosing cholangitis: Diagnosis and management},
  author={Phunchai Charatcharoenwitthaya and Keith D. Lindor},
  journal={Current Gastroenterology Reports},
  year={2006},
  volume={8},
  pages={75-82}
}
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease caused by progressive inflammatory destruction of intrahepatic and extrahepatic bile ducts, and ultimately cirrhosis. PSC occurs primarily in patients with underlying ulcerative colitis and affects primarily young to middle-aged men. PSC is believed to be an autoimmune disease mediated by immune dysregulation in patients with genetic susceptibility. One possible mechanism for the development of PSC is the homing of… 
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Biliary Stent Therapy for Dominant Strictures in Patients Affected by Primary Sclerosing Cholangitis
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References

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TLDR
Aside from viral hepatitis and alcoholic liver disease, primary sclerosing cholangitis is one of the most common indications for liver transplantation and research aimed toward better understanding the pathogenetic mechanisms and clinical trials with promising new agents are ongoing.
A Pilot Study of Etanercept in the Treatment of Primary Sclerosing Cholangitis
TLDR
Etanercept, at the dosage used, was well tolerated but not effective in the treatment of PSC, although it may be helpful in treating pruritus due to cholestasis.
Ursodiol for Primary Sclerosing Cholangitis
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.
Is there a role for liver biopsy in primary sclerosing cholangitis?
TLDR
Liver biopsies rarely contribute new information that affects the management of patients with PSC, and given the risks of the procedure, liver biopsy for patients with a diagnosis of PSC established by cholangiography may not routinely be necessary.
Sonographic detection of perihepatic lymphadenopathy is an indicator for primary sclerosing cholangitis in patients with inflammatory bowel disease
TLDR
In patients with IBD, detection of enlarged perihepatic lymph nodes in US predicted PSC more accurately than conventional serum parameters alone and the sensitivity ratio increased by a factor of 1.13 in favor of the US examination.
Risk factors for recurrence of primary sclerosing cholangitis of liver allograft
Patients with small duct primary sclerosing cholangitis have a favourable long term prognosis
TLDR
Patients with small duct PSC seem to have a good prognosis in terms of survival and development of cholangiocarcinoma.
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TLDR
Surgical bypass was once the primary means of palliation of jaundice in patients with unresectable cholangiocarcinoma but in the last 2 decades has been superseded by less invasive and less morbid nonsurgical procedures such as endoscopic and percutaneous biliary stent placement.
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TLDR
Tacrolimus (FK 506), a new and powerful immunosuppressive macrolide antibiotic, has been used to treat 10 patients with primary sclerosing cholangitis and it is anticipated that FK 506 will become an important agent for the treatment of patients with PSC because of its powerful immunOSuppressive activity.
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