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Primary sclerosing cholangitis

Cholestatic LFTs in a young man with colitis, MRCP for diagnosis, why UDCA isn't routine, surveillance for cholangiocarcinoma, gallbladder and colorectal cancer, dominant strictures and when to refer for transplant.

Tier 2Condition

Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made

3 questions 8 flashcards

At a glance

Chronic, progressive inflammation and fibrosis of the bile ducts, intrahepatic and extrahepatic, causing multifocal strictures.
Typical patient: man aged 30 to 40 with ulcerative colitis and a raised ALP found on routine bloods. About half have no symptoms at diagnosis.
MRCP makes the diagnosis. No drug changes the natural history.

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Sources

EASL Clinical Practice Guidelines on sclerosing cholangitis. J Hepatol 2022;77:761-806European Association for the Study of the Liver (Journal of Hepatology), 2022
Bowlus CL et al. AASLD practice guidance on primary sclerosing cholangitis and cholangiocarcinoma. Hepatology 2023;77:659-702American Association for the Study of Liver Diseases, 2022
Chapman MH et al. British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut 2019;68:1356-78British Society of Gastroenterology (Gut), 2019
Ursodeoxycholic acid: PBAC Public Summary Document, March 2023, and PBS medicine statusAU/NZPharmaceutical Benefits Scheme, Australian Government, 2023
Lindor KD et al. High-dose ursodeoxycholic acid for the treatment of primary sclerosing cholangitis. Hepatology 2009;50:808-14Hepatology, 2009
de Vries E et al. Fibrates for itch (FITCH) in fibrosing cholangiopathies: a double-blind, randomized, placebo-controlled trial. Gastroenterology 2021;160:734-43Gastroenterology, 2021
Mendes FD et al. Elevated serum IgG4 concentration in patients with primary sclerosing cholangitis. Am J Gastroenterol 2006;101:2070-5American Journal of Gastroenterology, 2006

Last updated: 14 November 2026

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