[Primary sclerosing cholangitis with chronic pancreatitis]

Area of Science:

• Gastroenterology
• Hepatology
• Endocrinology

Background:

• Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease.
• Pancreatic involvement in PSC is uncommon but can lead to severe functional impairment.
• This case highlights the interplay between biliary and pancreatic diseases.

Observation:

• A 68-year-old male with insulin-dependent diabetes presented with significant weight loss and elevated biliary enzymes.
• Imaging revealed a pancreatic head lesion, later diagnosed as chronic fibrosing pancreatitis.
• Radiology also demonstrated features consistent with PSC and pancreatic duct inflammation.

Findings:

• Treatment with ursodeoxycholic acid and pancreatic enzyme/insulin substitution normalized laboratory values.
• The patient experienced weight gain and significant regression of biliary and pancreatic duct abnormalities.
• Histological and biochemical improvements were observed in both biliary and pancreatic ducts.

Implications:

• Ursodeoxycholic acid demonstrates efficacy in managing pancreatic duct inflammation associated with PSC.
• This suggests a potential therapeutic role for ursodeoxycholic acid in similar complex cases.
• Early diagnosis and comprehensive management are crucial for improving outcomes in patients with co-existing PSC and pancreatic disease.