Primary Sclerosing Cholangitis (PSC) (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)
Dr. Anand received MBBS degree from Medical College Amritsar, University of Punjab. He completed his Internal Medicine residency at the Postgraduate Institute of medical Education and Research, Chandigarh, India. He was trained in the field of Gastroenterology and obtained the DPhil degree. Dr. Anand is board-certified in Internal Medicine and Gastroenterology.
In this Article
- Primary sclerosing cholangitis (PSC) definition
- What causes primary sclerosing cholangitis?
- What are the risk factors for primary sclerosing cholangitis?
- What are the signs and symptoms of primary sclerosing cholangitis?
- How is the diagnosis of primary sclerosing cholangitis made?
- What is the treatment for primary sclerosing cholangitis?
- Liver transplant
- What complications are associated with primary sclerosing cholangitis?
- Can primary sclerosing cholangitis be prevented?
- What is the prognosis and life expectancy for a person with primary sclerosing cholangitis?
- Find a local Gastroenterologist in your town
Liver transplant is the only "cure" for primary sclerosing cholangitis, but it is only recommended for patients whose disease has progressed to liver failure. The five year survival rate after transplantation is 85%.
The goal of liver transplantation is to restore liver function. Though unlikely, it is possible for PSC to recur in the new liver.
What complications are associated with primary sclerosing cholangitis?
PSC is a progressive disease, damaging the bile ducts and reducing the bile flow, ultimately leading to portal hypertension, cirrhosis, and liver failure.
Some cancers are associated with primary sclerosing cholangitis including gallbladder cancer, hepatocellular cancer (cancer of the liver cells) and cholangiocarinoma (cancer of the bile ducts). The combination of inflammatory bowel disease and PSC increases the risk of developing cancers of the colon and rectum
Can primary sclerosing cholangitis be prevented?
The specific cause of PSC is still unknown and therefore it seems not to be preventable. It is appropriate for patients with inflammatory bowel disease (especially ulcerative colitis) and their health care professional to be aware of the relationship with primary sclerosing cholangitis, in case symptoms suggestive of the disease arise. However, PSC is seen in only 3% of patients with inflammatory bowel disease.
What is the prognosis and life expectancy for a person with primary sclerosing cholangitis?
Aside from liver transplantation, there are no effective treatments for PSC. In the US, studies suggest that life expectancy ranges from 9 to 18 years if the patient does not undergo liver transplantation. Using different population study models, researchers in the Netherlands concluded that life expectancy may be longer than 21 years from the time when the diagnosis is made.
The prognosis and life expectance is poorer in older patients, those who have an enlarged liver and spleen, and in patients who are persistently jaundiced with elevated bilirubin levels in their bloodstream.
The five year survival rate for patients who undergo liver transplantation is 85%.
Boonstra K, et al. Population-based epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis. Hepatology 2013 Dec; 58(6):2045-55).
Razumilava N. et al. Cancer surveillance in patients with primary sclerosing cholangitis. Hepatology 2011 Nov; 54(5):1842-52.).
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