Sclerosing cholangitis

  • Definition
    • Sclerosing cholangitis refers to swelling (inflammation), scarring, and destruction of the bile ducts inside and outside of the liver.

  • Alternative Names
    • Primary sclerosing cholangitis; PSC

  • Causes
    • The cause of this condition is usually unknown.

      The disease may be seen in people who have:

      Genetic factors may also be responsible. Sclerosing cholangitis occurs more often in men than women. This disorder is rare in children.

      Sclerosing cholangitis may also be caused by:

      • Choledocholithiasis (gallstones in the bile duct)
      • Infections in the liver, gallbladder, and bile ducts
  • Symptoms
    • The first symptoms are usually:

      • Fatigue
      • Itching
      • Yellowing of the skin and eyes (jaundice)

      However, some people have no symptoms.

      Other symptoms may include:

  • Exams and Tests
  • Treatment
    • Medicines that may be used include:

      • Cholestyramine (such as Prevalite) to treat itching Ursodeoxycholic acid (ursodiol) to improve liver function
      • Fat-soluble vitamins (D, E, A, K) to replace what is lost from the disease itself
      • Antibiotics to treat infections in the bile ducts
      • Medicines to quiet the immune system (such as prednisone, azathioprine, cyclosporine, or methotrexate)

      These surgical procedures may be done:

      • Inserting a long, thin tube with a balloon at the end to open up narrowing (endoscopic balloon dilation of strictures)
      • Placement of a drain or tube for major narrowing (strictures) of bile ducts
      • Proctocolectomy (removal of colon and rectum, for those who have both ulcerative colitis and sclerosing cholangitis)
      • Liver transplant
  • Outlook (Prognosis)
    • How well people do varies. The disease tends to get worse over time, and sometimes people develop:

      • Ascites (buildup of fluid in the space between the lining of the abdomen and abdominal organs) and varices (enlarged veins)
      • Biliary cirrhosis (inflammation of the bile ducts)
      • Liver failure
      • Persistent jaundice

      Some people develop infections of the bile ducts that keep returning.

      People with this condition have an increased risk of developing cancer of the bile ducts (cholangiocarcinoma). They should be checked regularly with a liver imaging test and blood tests. People who also have inflammatory bowel disease may have an increased risk of developing cancer of the colon or rectum and should have periodic colonoscopy.

  • Possible Complications
  • References
    • Gordon FD. Primary sclerosing cholangitis. Surg Clin North Am. 2008;88:1385-407.

      Ross AS, Kowdley KV. Sclerosing cholangitis and recurrent pyogenic cholangitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 68.

      Sabbaghian S, Ahrendt SA. Primary Sclerosing Cholangitis. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:409-13.

      Wang C, Pressman A. Primary Sclerosing Cholangitis. In: Ferri FF, ed. Ferri's Clinical Advisor 2015. 1st ed. Philadelphia, PA: Elsevier Mosby; 2015:section I.