Ursodeoxycholic Acid in the Treatment of Primary Sclerosing Cholangitis

Abstract

Primary sclerosing cholangitis (PSC) is a cholestatic liver disease characterized by inflammation and obliterative fibrosis of bile ducts leading to their progressive destruction (1-4). As a consequence, cholestasis with elevated serum levels of alkaline phosphatase (AP) and gamme glutamyl transpeptidase (GGT) and bilirubin in more advanced disease is the most prominent feature of this disease. The diagnosis of PSC is primarily based on endoscopic retrograde cholangiography with demonstration of irregular strictures and dilatations. In liver biopsy, typical findings are portal and periodical inflammation and fibrosis. Since PSC is a focal disease, the characteristic histological findings may or may not be seen in a single liver biopsy. The cause of PSC is still unknown. The association with histocombatibility antigens indicates that immunological mechanisms may be involved but it is still unclear whether the disease is immunogenic. Alternatively, bacteria and bacterial toxins from the colon might play a role (3, 4). In 70% of cases PSC is associated with ulcerative colitis (5) and, therefore, in all patients with this intestinal disease who also have elevated levels of liver enzymes, a cholangiography should be performed. Recently, in up to 80% of patients with PSC anti-neutrophil-cytoplasmatic-antigens (ANCA) were found to be elevated (6) and, in future, this test may help to diagnose the disease more easily. Up to now, however, the disease is usually diagnosed at a relatively advanced stage when the patients have jaundice.

New Therapies in Hepatitis C Virus and Chronic Liver Disease: Antifibrotics

“…This cytoprotective action in turn theoretically reduces inflammation and may have a beneficial effect on fibrogenesis [93]. Although neither experimental nor human data indicate a primary antifibrotic effect, the compound has been examined extensively in humans in many different diseases [94][95][96][97][98][99][100][101][102]. The greatest experience has been in primary biliary cirrhosis, a disease in which results have been mixed.…”

Hepatic Fibrosis and Cirrhosis

“…200 Neither experimental data nor human studies indicate a primary antifibrotic effect of ursodeoxycholic acid in the liver, but the compound has been examined extensively. [201][202][203][204][205][206][207][208][209] Ursodeoxycholic acid has been studied in patients with cystic fibrosis, primary biliary injury (primary biliary cirrhosis, primary sclerosing cholangitis and progressive familial intrahepatic cholestasis), and miscellaneous liver diseases. Results with ursodeoxycholic acid in these conditions have been mixed.…”

Współczesne poglądy na postępowanie diagnostyczne i terapeutyczne w zespołach nakładania (overlap syndromes) w chorobach wątroby

“…Pacjenci z ZN AIH z innym zespołem cholestatyczym powinni być leczeni w monoterapii GKS, UDCA lub w skojarzeniu -w zależno-ści od stężenia FA w surowicy krwi. Endoskopowe metody poszerzania zwężeń zawnątrzwątrobowych dróg żółciowych lub ich stentowania są wskazane we wszystkich przypadkach ZN z PSC, w których jest to technicznie możliwe [21,22].…”