GASTROENTEROLOGY ARTICLE OF THE WEEK
March 12, 2009
Tischendorf JJ, Geier A, Trautwein C. Current diagnosis and management of primary Sclerosing Cholangitis. Liv Transpl 2008;14:735-46.
1. Indications for liver biopsy in PSC include
a. all patients with suspected PSC should be biopsied to establish the diagnosis
b. To stage the disease
c. To establish the diagnosis of small duct PSC
d. To help determine if an autoimmune-PSC overlap exists
2. Risk factors for cholangiocarcinoma in PSC include
a. Presence of cirrhosis of the liver
b. Smoking
c. Colon cancer arising in IBD
d. Long history of IBD
e. Degree of elevation of alkaline phosphatase
f. Alcohol use
3. After undergoing liver transplantation for PSC
a. Recurrence of PSC is extremely rare
b. Symptoms of IBD respond well to immunosuppression and IBD is rarely a problem
c. Retransplantation rates are higher for patients transplanted for PSC
d. Risk of colon cancer in IBD patients is higher after transplant
e. Colonoscopic surveillance for colon cancer should be yearly after transplant regardless of the duration of the IBD
True or False
4. A positive pANCA is a strong predictor for PSC and is felt to be associated with the pathogenesis of PSC
5. A diagnosis of cholangiocarcinoma is an indication for expedited liver transplantation
6. Cholangiocarcinoma in PSC typically develops after cirrhosis is present
7. Hepatobiliary malignancies develop in 6% to 20% of patients with PSC
8. The best approach to evaluating a biliary stricture in PSC to exclude cancer is obtaining cytology, ideal with FISH (fluorescence in situ hybridization)
9. Over 95% of PSC patients have IBD
10. The preferred endoscopic approach to dominant strictures causing hyperbilirubinemia is balloon dilation without stent placement
11. The prevalence of PSC in IBD is 2-7%
12. Patients with elevated alkaline phosphatase in conjuction with IBD but a normal cholangiogram are often labeled as “small duct PSC” and with time, most will develop classical PSC
13. Progression of PSC is variable, occasionally the disease spontaneously resolves
14. Ursodeoxycholic acid therapy consistently improves liver biochemical parameters but does not lead to improved survival, nor does it appear to reduce risk of colon cancer