Primary Sclerosing Cholangitis (PSC)

You may have no symptoms of PSC and first learn you have it when it’s detected in a blood test. If you do have symptoms, they may develop slowly, come and go, and may – or may not – get worse over time. Bile that backs up into your liver can cause cirrhosis, which can lead to liver failure. It can also lead to bile duct infections, and long term bile duct inflammation may lead to bile duct cancer. Common symptoms of primary sclerosing cholangitis include:

• Itchy skin
• Fatigue
• Belly pain over the liver area
• Yellowing of the skin and eyes (jaundice)
• Chills and fever (from infection in your bile ducts)

It’s believed that an overactive immune system causes primary sclerosing cholangitis, but what triggers this over-activity still isn’t clearly known. A genetic predisposition for PSC likely exists, and exposure to certain bacteria, viruses or toxins is believed to somehow trigger the immune system, which reacts in an inappropriate way and causes injury to the bile ducts. Primary sclerosing cholangitis is often diagnosed between the ages of 30 to 40, and it’s more common in men and patients with inflammatory bowel disease.

A routine blood test showing abnormal liver enzymes can help determine if you have primary sclerosing cholangitis (an increase in these enzymes is due to bile duct injury). The diagnosis can be confirmed using one of several methods:

• Magnetic resonance cholangiopancreatography (MRCP). This test uses magnetic waves and a computer program to obtain and reconstruct images of your bile ducts. Dye may be injected into your blood at the same time to obtain additional details about the liver tissue. This is the most common test used to diagnose PSC.
• Endoscopic retrograde cholangiopancreatography (ERCP). This test involves the use of an endoscope, a long, thin tube with a tiny camera and light on one end. The scope is inserted through your mouth and down into your small intestine, which allows a catheter to be inserted through the scope into the bile ducts. Dye is injected through the catheter into your bile ducts and X-ray pictures are taken. This test allows for both the diagnosis and treatment of PSC, should narrowed bile ducts be found.
• Percutaneous transhepatic cholangiography. In this study, a catheter with a needle is inserted through the skin into your liver; dye is injected into your bile ducts to obtain X-ray pictures. Similar to the ERCP, if blocked bile ducts are found, they can be opened up.
• Liver biopsy. A small sample of liver tissue is taken and checked under a microscope. It can confirm the diagnosis of PSC and provide information on the presence and severity of scar tissue. It also allows your doctor to examine your liver for other diseases.

While there is no cure for primary sclerosing cholangitis, many of its complications can be managed.

• Medications such as bile acid sequestrants and antibiotics can help relieve the itching and infections caused by PSC.
• Vitamin supplements can help your body get the nutrients you need, including vitamins for bone health. Osteoporosis (brittle bones) is common in patients with primary sclerosing cholangitis, and your bone density needs to be monitored by your doctor.
• People with primary sclerosing cholangitis are at increased risk for cancers of the bile duct, liver, gallbladder and colon. If you have inflammatory bowel disease (IBD), you should have a colonoscopy every year to check for colon cancer. Even if you do not have IBD, a colonoscopy with biopsies should be done when you are diagnosed with PSC to evaluate for IBD.

If primary sclerosing cholangitis eventually causes your liver to fail or leads to bile duct cancer, your doctor may recommend a liver transplant. Liver transplants can cure primary sclerosing cholangitis, although it may recur in the new liver in a small number of patients.

See liver transplant evaluation locations in Chicagoland

Our liver disease specialists work closely with UChicago Medicine researchers to offer patients access to the advanced treatment options and clinical trials for primary sclerosing cholangitis.