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Huang CS, Lichtenstein DR. Treatment of Biliary Problems in Inflammatory Bowel Disease. Curr Treat Options Gastroenterol. 2005;8(2):117-126doi: 10.1007/s11938-005-0004-1.
Huang, C. S., & Lichtenstein, D. R. (2005). Treatment of Biliary Problems in Inflammatory Bowel Disease. Current treatment options in gastroenterology, 8(2), 117-126. https://doi.org/10.1007/s11938-005-0004-1
Huang, Christopher S, and Lichtenstein, David R. "Treatment of Biliary Problems in Inflammatory Bowel Disease." Current treatment options in gastroenterology vol. 8,2 (2005): 117-126. doi: https://doi.org/10.1007/s11938-005-0004-1
Huang CS, Lichtenstein DR. Treatment of Biliary Problems in Inflammatory Bowel Disease. Curr Treat Options Gastroenterol. 2005 Apr;8(2):117-126. doi: 10.1007/s11938-005-0004-1. PMID: 15769433.
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Curr Treat Options Gastroenterol. 2005 Apr;8(2):117-126. doi: 10.1007/s11938-005-0004-1.

Treatment of Biliary Problems in Inflammatory Bowel Disease.

Current treatment options in gastroenterology

Christopher S Huang, David R Lichtenstein

Affiliations

  1. Boston University School of Medicine, Boston Medical Center, 85 East Concord Street, Boston, MA 02118, USA. [email protected].

PMID: 15769433 DOI: 10.1007/s11938-005-0004-1

Abstract

The most common biliary problem in patients with inflammatory bowel disease is primary sclerosing cholangitis (PSC). The treatment of this disease is multifaceted and frequently requires a multidisciplinary approach involving internists, nutritionists, gastroenterologists, and surgeons. Unfortunately, other than liver transplantation, no therapy that is currently available has been proven to alter the natural history of PSC or prolong survival. Ursodeoxycholic acid is currently the most promising pharmacologic treatment option for slowing disease progression and should be used in higher than usual doses (20 to 30 mg/kg/d). Treatment of symptoms due to cholestasis, such as pruritis and steatorrhea, is an important aspect of the medical care of patients with PSC. Our preferred treatment of pruritis due to cholestasis is with bile acid binding exchange resins such as cholestyramine or colestipol (which is generally better tolerated than cholestyramine). Endoscopic therapy should be reserved for patients with obstructive jaundice, cholangitis, or symptomatic dominant biliary strictures. We recommend dilation of dominant strictures with graduated or balloon dilators followed by temporary stenting if the postdilation cholangiographic appearance is not improved or adequate biliary drainage cannot be assured. There is indirect evidence that the combination of ursodeoxycholic acid and endoscopic therapy to maintain biliary patency may improve transplant-free survival in patients with PSC, although this remains to be proven. Liver transplantation remains the only effective treatment of advanced PSC, and should be considered in patients with complications of cirrhosis or intractable pruritis or fatigue.

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