The 2024 diagnostic criteria for primary sclerosing cholangitis

Area of Science:

• Hepatology
• Gastroenterology
• Medical Diagnostics

Background:

• Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease with limited diagnostic biomarkers and a poor prognosis.
• Existing 2016 diagnostic criteria for PSC, based on cholangiography and biliary enzymes, have limitations, particularly for specific patient groups.

Purpose of the Study:

• To introduce and validate the 2024 diagnostic criteria for primary sclerosing cholangitis (PSC).
• To address limitations of the 2016 criteria and expand diagnostic applicability to diverse PSC presentations, including pediatric and small duct PSC, and post-liver transplant recurrence.

Main Methods:

• A multidisciplinary expert working group convened by the Intractable Hepato-Biliary Diseases Study Group in Japan developed the 2024 criteria.
• The process involved extensive discussions and public hearings, incorporating novel findings and knowledge in PSC diagnosis.
• The criteria now include magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiography (ERC), and gamma-glutamyl transferase (GGT) for pediatric cholestasis evaluation.

Main Results:

• The 2024 criteria provide enhanced diagnostic capabilities for small duct PSC, pediatric PSC, and PSC recurrence after liver transplantation.
• Diagnostic imaging now includes both MRC and ERC, offering greater flexibility.
• Liver biopsy and characteristic biliary findings are incorporated for diagnosing PSC recurrence post-transplantation.

Conclusions:

• The 2024 diagnostic criteria for PSC represent a significant advancement over the 2016 guidelines.
• These updated criteria aim to improve the diagnosis and management of various PSC forms across different patient populations.
• The criteria are expected to benefit a wide range of healthcare professionals, including hepatologists, gastroenterologists, pediatric specialists, and transplant surgeons.