Ursodeoxycholic acid therapy for primary sclerosing cholangitis: Results of a 2-year randomized controlled trial to evaluate single versus multiple daily doses

Hoogstraten, H. J. F. van; Wolfhagen, Frank H.J.; Meeberg, Paul C. van de; Kuiper, Hillechien; Nix, G. A. J. J.; Becx, Marco C.; Hoek, A.; Houte, Dennis P.F. van; Rijk, M. C. M.; Salemans, J.M.J.I.; Scherpenisse, Joost; Schrijver, M.; Smit, Adelbert M.; Spoelstra, P.; Stadhouders, P.H.G.M.; Tan, T.G.; Hop, Wim C. J.; Kate, Fiebo J.W. ten; vanBerge-Henegouwen, Gerard P.; Schalm, Solko W.; Buuren, Henk R. van

doi:10.1016/s0168-8278(98)80059-7

Cited by 73 publications

(29 citation statements)

References 24 publications

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“…It is also the most extensively studied [58] with some, but not all, studies showing improvements in biochemistry, symptoms and histology [59][60][61][62][63][64] . The most promising data is for long term UDCA used at high dose, 20-30 mg/kg per day (in divided doses), as this may increase clinical benefit and decrease histological progression of disease [65,66] .…”

Section: Psc Treatmentmentioning

confidence: 99%

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Saich¹,

Chapman²

2008

WJG

117

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(AIH) is also more prevalent in patients with IBD, with up to 16% of patients with AIH also having ulcerative colitis. A small subgroup of patients have a AIH-PSC overlap syndrome and the management of these patients depends on liver histology, serum IgM levels, autoantibodies, degree of biochemical cholestasis and cholangiography as some of these patients may respond to immunosupression. INTRODUCTIONThe first association between colonic ulceration and liver disease was made in 1874 by Thomas CH, who described a young man who died of a 'much enlarged, fatty liver in the presence of ulceration of the colon' [1] . The association was confirmed by James Lister in 1899, who reported a patient with ulcerative colitis and secondary diffuse hepatitis [2] . Over the next 100 years it has become well established that there is a close relationship between inflammatory bowel disease and various hepatobiliary disorders. These disorders are listed in Table 1. PRIMARY SCLEROSING CHOLANGITISFirst described by Smith and Loe in 1965 [3] Primary sclerosing cholangitis (PSC) is a chronic progressive disorder of unknown aetiology characterised by inflammation, fibrosis and stricture formation in medium and large sized ducts in the biliary tree [4,5] . Common symptoms include itch and lethargy although many patients (up to 45%) are asymptomatic, even with advanced disease [5] . The disease is strongly associated with Inflammatory Bowel Disease and may be detected as an incidental finding of a raised serum alkaline phosphatase. www.wjgnet.comRe b e c c a S a i c h , Ro g e r C h a p m a n , AbstractPrimary sclerosing cholangitis (PSC) is a chronic progressive disorder of unknown aetiology characterised by chronic inflammation and stricture formation of the biliary tree.

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Section: Psc Treatmentmentioning

confidence: 99%

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Saich¹,

Chapman²

2008

WJG

117

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“…Similar to PBC, all studies showed a marked reduction in cholestasis [97, 98, 99, 100, 101], and even bilirubin, a strong prognostic marker, improved. Thus, UDCA is considered as the treatment of choice for patients with all stages of PSC.…”

Section: Treatment Of Pscmentioning

confidence: 84%

Medical Treatment of Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Holtmeier

Leuschner²

2001

Digestion

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Treatment of primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) with ursodeoxycholic acid (UDCA) has been in common use since 1985. In PBC, treatment with UDCA improves laboratory data, liver histology, enables a longer transplantation-free interval and prolongs disease survival. Because UDCA is unable to cure the disease newer drugs or combination therapies are still needed. Studies with UDCA and immunosuppressants such as prednisone, budesonide and azathioprine have shown that in selected patients combination therapy may be superior to UDCA monotherapy. PSC is treated successfully with UDCA and endoscropic dilatation of the bile duct strictures. Treatment of extrahepatic manifestations of cholestatic liver disease such as pruritus, fatigue, osteoporosis and steatorrhea can be problematic and time-consuming.

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“…Methotrexate (28), corticosteroids (29), cyclosporine (30), azathioprine, and 6-mercaptopurine (31) have not been proven beneficial. UDCA has been shown to improve liver biochemistry and histology, but has not been shown to alter the progression (32,33). Infliximab therapy may be efficacious.…”

Section: Discussionmentioning

confidence: 99%

Crohn's Disease and Primary Sclerosing Cholangitis: A Case Report and Review of the Literature

Miao

Sun²,

Hong³

et al. 2012

Intern. Med.

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The comorbidity of Crohn's disease (CD) and primary sclerosing cholangitis (PSC) is uncommon. Diagnosing such patients can be difficult, as illustrated by the following case. The combination of CD and PSC should be considered in patients with CD who have abnormal liver function. Because patients with PSC often present asymptomatically, all patients with CD should be screened for PSC by checking serum liver tests. Review of the literature suggests that there is an increased potential in these patients for the development of malignancy and long-term prognosis is poor. We conclude that patients diagnosed with a combination of CD and PSC should be managed with periodic colonoscopy, CA 19-9 investigation, early liver and bowel imaging, and liver biopsy. The treatment of CD associated with PSC remains unsatisfactory and the possibility of liver transplantation should be considered.

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Ursodeoxycholic acid therapy for primary sclerosing cholangitis: Results of a 2-year randomized controlled trial to evaluate single versus multiple daily doses

Cited by 73 publications

References 24 publications

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Medical Treatment of Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Crohn's Disease and Primary Sclerosing Cholangitis: A Case Report and Review of the Literature

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