Primary Sclerosing Cholangitis (PSC)

There is a very strong connection between PSC and Inflammatory Bowel Disease.

• Approximately 70–80% of patients with PSC also have IBD (most commonly Ulcerative Colitis).

• Because of this link, any patient diagnosed with PSC requires a "screening" colonoscopy, even if they have no bowel symptoms.

• Patients with IBD who have PSC, have higher risk of developing bowel cancer, and are recommended to undergo annual colonoscopy for surveillance.

Given that PSC affects the bile duct system, a combination of tests are used for diagnosis:

1. Liver function tests – Blood tests show elevation of specific enzymes (example alkaline phosphatase) which may indicate obstruction of bile ducts.

2. MRCP scan – This is a specialised MRI scan which provides high-resolution images of the bile ducts, and can identify narrowing or ‘beading’ of the ducts seen in PSC

3. Liver biopsy – Occasionally, especially when PSC is suspected to effect tiny ducts within the liver (which can not be distinctly seen at MRCP), liver biopsy may be needed.

Most people with PSC experience no symptoms. As condition progresses, people with PSC may notice itch, jaundice, or other symptoms such as pain and fever especially which may suggest development of infection in bile ducts.

Patients with PSC have an increased risk of liver cancer and gall bladder cancer. Those patients with co-existing IBD, have in addition, an increased risk of bowel cancer.

Given this, regular scans of liver may be recommended. Similarly, annual colonoscopies are also strongly recommended to identify and treat pre-cancerous lesions in the bowel.

As of now, there is no cure for PSC, and intervention are aimed at managing complications for PSC.

If one of the larger bile ducts becomes severely blocked, based on symptoms, specific endoscopic treatment (ERCP) may be recommended to stretch the narrowing, and obtain biopsies. In patients, where infection in bile duct is suspected, antibiotics may be required.