Primary sclerosing cholangitis: value of cholangiography in determining the prognosis.

Craig, Daniel A.; MacCarty, Robert L.; Wiesner, R H; Grambsch, Patricia M.; LaRusso, N. F.

doi:10.2214/ajr.157.5.1927817

Cited by 77 publications

(56 citation statements)

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“…Cholangiograms were performed with balloon catheter occlusion whenever possible, to ensure adequate filling pressure in intrahepatic peripheral branches. ERCP findings were classified according to Craig et al 19 and by global assessment, with findings graded as "improvement," "no change," or "worsening." The New Mayo Risk Score was calculated at entry and at the end of the treatment period using the revised PSC Mayo Risk Score 20 : risk ϭ 0.03 ϫ age (yr) ϩ 0.54 ϫ log e (total bilirubin [mg/dL]) Ϫ 0.84 ϫ albumin (g/dL) ϩ 0.54 ϫ log e (AST IU/L) ϩ 1.24 ϫ variceal bleeding (yes ϭ 1; no ϭ 0).…”

Section: Methodsmentioning

confidence: 99%

Metronidazole and ursodeoxycholic acid for primary sclerosing cholangitis: A randomized placebo-controlled trial

et al. 2004

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No effective medical therapy is currently available for primary sclerosing cholangitis (PSC). Ursodeoxycholic acid (UDCA) improves liver enzymes, but its effect on liver histology is controversial. Metronidazole (MTZ) prevents PSC-like liver damage in animal models and reduces intestinal permeability. We recruited 80 patients with PSC into a randomized placebo-controlled study to evaluate the effect of UDCA and MTZ (UDCA/MTZ) compared with UDCA/placebo on the progression of PSC. Patients (41 UDCA/placebo and 39 UDCA/ MTZ) were followed every third month. Assessment of liver function test, histological stage and grade, and cholangiography (via ERCP) at baseline showed no differences between the groups. After 36 months, serum aminotransferases ␥-glutamyltransferase, and alkaline phosphatase (ALP) decreased markedly in both groups, serum ALP more significantly in the UDCA/MTZ group (؊337 ؎ 54 U/L, P < .05) compared with the UDCA/placebo group. The New Mayo Risk Score decreased markedly only in the UDCA/MTZ group (؊0.50 ؎ 0.13, P < .01). The number of patients with improvement of stage (P < .05) and grade (P < .05) was higher in the combination group. ERCP findings showed no progression or improvement in 77% and 68% of patients on UDCA/MTZ and UDCA/placebo, respectively. In conclusion, combining MTZ with UDCA in PSC improved serum ALP levels and New Mayo Risk Score, but no statistically significant effect on disease progression as assessed via liver histology or ERCP was seen. Long-term studies using a higher dose of UDCA combined with MTZ in larger patient populations are indicated. (HEPATOLOGY 2004;40:1379 -1386

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Section: Methodsmentioning

confidence: 99%

Metronidazole and ursodeoxycholic acid for primary sclerosing cholangitis: A randomized placebo-controlled trial

et al. 2004

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“…The classification of Ponsioen et al (23) has been validated and shown to correlate with patient prognosis 6 ( Table 2). Another type of classification is based on evaluation of the grade, length, and extent of strictures, the degree of bile duct dilatation, and the distribution of lesions (24). None of the ductographic criteria published are specific for PSC and the findings must be interpreted in the context of patient demographics and the clinical context.…”

Section: Ductographic Criteria For Pscmentioning

confidence: 99%

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Aabakken¹,

Karlsen²,

Albert³

et al. 2017

Journal of Hepatology

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“…Patients with a DS may remain asymptomatic or may present with worsening serum liver tests, abdominal pain, and/or cholangitis 9. Even if asymptomatic, a DS may not be without clinical consequence; indeed, studies suggest that its mere presence is associated with poorer prognosis in PSC 13, 14…”

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confidence: 99%

Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

Hilscher

Tabibian

Carey

et al. 2018

Hepatology Communications

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Dominant strictures (DSs) of the biliary tree occur in approximately 50% of patients with primary sclerosing cholangitis (PSC) and may cause significant morbidity. Nevertheless, the definition and management of DSs lacks consensus. We aimed to better understand current perceptions and practices regarding PSC‐associated DSs. We conducted an anonymous, 23‐question, survey‐based study wherein electronic surveys were distributed to 131 faculty in the Division of Gastroenterology and Hepatology at the three Mayo Clinic campuses (Rochester, Scottsdale, and Jacksonville) as well as the affiliated practice network. Responses were aggregated and compared, where applicable, to practice guidelines of the American Association for the Study of Liver Diseases and European Association for the Study of the Liver. A total of 54 faculty (41.2%) completed the survey, of whom 24 (44.4%) were hepatologists, 21 (38.9%) gastroenterologists, and 9 (16.7%) advanced endoscopists. One of the major study findings was that there was heterogeneity among participants' definition, evaluation, management, and follow‐up of DSs in PSC. The majority of participant responses were in accordance with societal practice guidelines, although considerable variation was noted. Conclusion: Despite the prevalence and morbidity of DSs in PSC, clinical perceptions and practices vary widely among hepatologists, gastroenterologists, and advanced endoscopists who manage these patients, even within a single health care system. Further studies are needed to address these variations, develop general and evidence‐based consensus, and increase adherence to societal guidelines. (Hepatology Communications 2018;2:836‐844)

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Primary sclerosing cholangitis: value of cholangiography in determining the prognosis.

Cited by 77 publications

References 0 publications

Metronidazole and ursodeoxycholic acid for primary sclerosing cholangitis: A randomized placebo-controlled trial

Metronidazole and ursodeoxycholic acid for primary sclerosing cholangitis: A randomized placebo-controlled trial

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

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