Management Of Primary Sclerosing Cholangitis

Management of primary sclerosing cholangitis (PSC) can be divided into endoscopic, medical, and surgical treatments. Whereas endoscopic therapy is primarily used to manage dominant strictures, medical treatment is directed both at modifying course of the disease and at symptomatic relief. Ursodeoxycholic acid is the most promising disease-modifying agent. Corticosteroids and other immunosuppressive agents do not have a proven role. Cholestyramine and rifampicin improve pruritis but response to these agents cannot be reliably predicted. Opioid antagonists are useful in refractory pruritis. All patients with advanced PSC should be offered bone mineral-density measurement and, if needed, treatment for osteoporosis. These approaches are not mutually exclusive and are often used concurrently or in sequence depending on the clinical situation. Liver transplantation is the only therapy that improves survival. In this review, we discuss the various management options for PSC.