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World J Hepatol. Jun 27, 2011; 3(6): 137-141
Published online Jun 27, 2011. doi: 10.4254/wjh.v3.i6.137
Management of primary sclerosing cholangitis
Holger H Lutz, Jens JW Tischendorf
Holger H Lutz, Jens JW Tischendorf, Medical Department III(Gastroenterology, Hepatology and Metabolic Diseases), University Hospital Aachen (RWTH), Aachen, Germany
Author contributions: Lutz HH drafted the article; Tischendorf JJW provided critical revision and final approval of the version to be published.
Correspondence to: Jens JW Tischendorf, MD, Medical Department III (Gastroenterology, Hepatology and Metabolic Diseases), University Hospital Aachen (RWTH), Pauwelsstr. 30, Aachen 52074, Germany. jtischendorf@ukaachen.de
Telephone: +49-241-80-80860 Fax: +49-241-80-82455
Received: December 24, 2010
Revised: May 10, 2011
Accepted: May 17, 2011
Published online: June 27, 2011

Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease with major morbidity and mortality. Therapeutic management is difficult, due to lack of conclusive data and individual disease progression. High-dose UDCA was used for years as a pharmacotherapeutic agent to prevent disease progression, based on a positive trend in pilot studies, but has recently been proven to have a negative effect in advanced disease. Immunosuppressants might be useful in patients with overlap syndromes. Dominant bile duct stenoses should be treated endoscopically, and cholangiocellular carcinoma (CCC) still remains a therapeutic challenge in PSC patients. Early diagnosis of CCC must be improved and new strategies such as neoadjuvant radiochemotherapy with subsequent liver transplantation in selected patients are further options to be considered.

Keywords: Primary sclerosing cholangitis, Ursodeoxycholic acid, NorUDCA, Cholangiocellular carcinoma, Cholestatic liver disease, Endoscopy, Dominant stenoses