Primary Sclerosing Cholangitis

Sclerosing cholangitis encompasses a spectrum of disorders, characterised by multi-level biliary stricturing. The prefix 'primary' refers to the commonest form, PSC. Although rare, incidence and prevalence are rising, which when coupled with the absence of life-prolonging therapy has resulted in PSC being one of the lead indications for liver transplantation. Herein, we present a clinically focussed overview of PSC epidemiology, natural history, and nuances surrounding monitoring and surveillance. We go on to discuss how gut inflammation may affect the clinical course that patients experience, whilst giving way to bile acid therapies, molecularly targeted antifibrotics, and a bevy of microbiome-based interventions.