Lecture: Updates in cholestatic liver disease

This was an excellent lecture about PSC and PBC; recent clinical advances and best-practice guidelines were discussed.  The take home messages are provided here:

In primary sclerosing cholangitis (PSC) pathogenic mechanisms are still poorly defined.  There is increasing evidence of the role of the gut microbiome as a triggering event in its natural history.  No medications are considered a standard of care at this time; high dose ursodiol increases mortality.  There still may be clinical benefit from low-dose ursodiol in the way of decreasing risk of colonic dysplasia. Screening for colorectal cancer is very important and should begin at the time of diagnosis.

For primary biliary cirrhosis (PBC) a treatment goal is: treat early!  Late stage fibrosis is more likely to be refractory to medical therapy.  Regardless of stage, ursodiol is the accepted standard of care.  Be wary of non-response (biochemical) at the end of one year of treatment.  Consider the addition of colchicine or mycofenolate in such cases where LFT do not normalize.

For the most recent AASLD guidelines (2009) for primary biliary cirrhosis, click on the link here:  PBC: 2009 AASLD Guidelines

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