Colorectal cancer in inflammatory bowel disease: The risk, pathogenesis, prevention and diagnosis8/10/2014 Colorectal cancer in inflammatory bowel disease: The risk, pathogenesis, prevention and diagnosis
Eun Ran Kim and Dong Kyung Chang Patients with inflammatory bowel disease (IBD) are at increased risk for developing colorectal cancer (CRC), although the overall incidence of IBD-associated CRC has been diminishing in recent decades in western countries. As demonstrated in previous studies, the risk of CRC in IBD increases with longer duration, extent of colitis, a familial history of CRC, coexistent primary sclerosing cholangitis, and the degree of inflammation. The pathogenesis of CRC in IBD is poorly understood ... Please click here to read the full article. World J Gastroenterol. 2014 August 7; 20(29): 9872-9881. Published online 2014 August 7. doi: 10.3748/wjg.v20.i29.9872. Primary sclerosing cholangitis during childhood and adolescence
Tamir Miloh and Pinar Bulut, Clinical Liver Disease Special Issue: Liver Disease in Children Volume 2, Issue 5, pages 215–218, October 2013 Primary sclerosing cholangitis (PSC) is an idiopathic, chronic hepatobiliary disorder characterized by inflammation with progressive obliterative fibrosis and focal dilatation of the intrahepatic and/or extrahepatic bile ducts which leads to biliary cirrhosis and end-stage liver disease.[1] The clinical features of PSC in children and adolescents are summarized in Table 2. PSC is more common in Caucasian male patients and has a strong association with inflammatory bowel disease (IBD), especially ulcerative colitis. In children, secondary causes of sclerosing cholangitis include Langerhans cell histiocytosis, immunodeficiencies, and cystic fibrosis. The incidence of PSC in children is 0.23 cases per 100,000 person-years compared with 1.11/100,000 in adults.[2] . . . Please click here to access the full text of this article. There is also a video presentation and an interview with the authors Randomised clinical trial: vancomycin or metronidazole in patients with primary sclerosing cholangitis - a pilot study
J. H. Tabibian, E. Weeding, R. A. Jorgensen, J. L. Petz, J. C. Keach, J. A. Talwalkar, K. D. Lindor Alimentary Pharmacology & Therapeutics Volume 37, Issue 6, pages 604–612, March 2013 Summary Background Emerging data suggest that oral antibiotics may have therapeutic effects in primary sclerosing cholangitis (PSC), but published studies are limited. Aims To investigate the safety and efficacy of oral vancomycin and metronidazole in patients with PSC. Methods Thirty-five patients with PSC were randomised in a double-blind manner into four groups: vancomycin 125 mg or 250 mg four times/day, or metronidazole 250 mg or 500 mg three times/day for 12 weeks. The primary endpoint was decrease in alkaline phosphatase (ALK) at 12 weeks. Secondary end points included serum bilirubin and Mayo PSC risk score; pruritus; and adverse effects (AEs). Nonparametric tests were used for analysis. Results The primary endpoint was reached in the low-dose (−43% change in ALK, P = 0.03) and high-dose (−40%, P = 0.02) vancomycin groups, with two patients in the former experiencing ALK normalisation . . . Please click here to read the full text of this article Note: The reference list of the article provides links to other full text articles. Successful Treatment of Recurrent Primary Sclerosing Cholangitis after Orthotopic Liver Transplantation with Oral Vancomycin
Yinka K. Davies, Cynthia J. Tsay, Dario V. Caccamo, Kathleen M. Cox, Ricardo O. Castillo, and Kenneth L. Cox Case Reports in Transplantation Volume 2013 (2013), Article ID 314292, 5 pages http://dx.doi.org/10.1155/2013/314292 Abstract Primary sclerosing cholangitis (PSC) is a progressive, cholestatic disease of the liver that is marked by inflammation of the bile ducts and damage to the hepatic biliary tree. Approximately 60–70% of patients also have inflammatory bowel disease and progression of PSC can lead to ulcerative colitis and cirrhosis of the liver. Due to limited understanding of the etiology and mechanism of PSC, the only existing treatment option is orthotopic liver transplantation (OLT); however, recurrence of PSC, after OLT is estimated to be between 5% and 35%. We discuss the successful treatment of a pediatric patient, with recurrent PSC, after OLT with oral Vancomycin ... Please click here to access to the full text of this article Normalization of Serum Alkaline Phosphatase in Primary Sclerosing Cholangitis Associated with Ulcerative Colitis Mitsuro Chiba, Hidehiko Tsuda, Satoko Tsuda, Masafumi Komatsu, Yasuo Horie, Hirohide Ohnishi Abstract Primary sclerosing cholangitis (PSC) is commonly associated with ulcerative colitis (UC). PSC progresses independently of UC ultimately resulting in liver failure. There is no established medi- cal treatment to improve the natural course of PSC. Normalization of serum alkaline phosphatase (ALP) in early stage might delay the progress of PSC. A 20-year-old female, had a sudden attack of right hypochondralgia with high fever and abnormal liver function tests without elevation of bili- rubin: ALP 478 IU/L, aspartate aminotransferase 360 IU/L, alanine aminotransferase 174 IU/L. Abnormal liver function tests returned to normal after the attacks. Morphological examinations initially indicated then confirmed a diagnosis of PSC. One month after displaying PSC symptoms administration of ursodeoxycholic acid was initiated. Similar attacks of cholangitis were repeated several times over the following two years. Even in the absence of these attacks, she always suf- fered postprandial hypochondralgia ... Full article available by clicking on the title Copyright © 2014 by authors and Scientific Research Publishing Inc This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Inflammatory bowel disease of primary sclerosing cholangitis: A distinct entity?
Takahiro Nakazawa, Itaru Naitoh, Kazuki Hayashi, Hitoshi Sano, Katsuyuki Miyabe, Shuya Shimizu and Takashi Joh, World J Gastroenterol 2014 March 28; 20(12): 3245-3254 This is a review of the characteristic findings of inflammatory bowel disease (IBD) associated with primary sclerosing cholangitis (PSC) and their usefulness in the diagnosis of sclerosing cholangitis. PSC is a chronic inflammatory disease characterized by idiopathic fibrous obstruction and is frequently associated with IBD. IBD-associated with PSC (PSC-IBD) shows an increased incidence of pancolitis, mild symptoms, and colorectal malignancy. Although an increased incidence of pancolitis is a characteristic finding, some cases are endoscopically diagnosed as right-sided ulcerative colitis . . . To read further please click on the title. Prospective evaluation of ursodeoxycholic acid withdrawal in patients with primary sclerosing cholangitis
Ewa Wunsch, Jocelyn Trottier, Malgorzata Milkiewicz, Joanna Raszeja-Wyszomirska, Gideon M Hirschfield, Olivier Barbier, Piotr Milkiewicz. Hepatology: Official Journal of the American Association for the Study of Liver Diseases, 2014, February 12 Ursodeoxycholic acid (UDCA) is no longer recommended for the management of adult patients with primary sclerosing cholangitis (PSC). We undertook prospective evaluation of UDCA withdrawal in a group of consecutive patients with PSC. Twenty six patients, all treated with UDCA (dose range 10-15mg/kg/day) were included. Paired blood samples for liver biochemistry, bile acids, fibroblast growth factor 19 (FGF19) were collected before UDCA withdrawal and 3 months later . . . To read further, please click on the title. Recurrence of primary sclerosing cholangitis in pediatric liver transplant recipients
Veena L. Venka, Sarangarajan Ranganathan, George V. Mazariegos, Qing Sun, Rakesh Sindhi Abstract Purpose: There is little detailed clinical data on rPSC after LTx in children. Our purpose was to describe patient characteristics in children who experienced rPSC after LTx to identify potential risk factors for recurrence. Methods: Clinical information of pediatric patients transplanted for PSC was retrospectively reviewed, and variables related to the pre-transplant diagnosis of PSC and post-transplant variables were abstracted. Variables studied include CMV/EBV status, early/late rejection, induction regimen, immunosuppression in the first year, steroid-resistant rejection, diagnosis of inflammatory bowel disease (IBD), and HLA markers commonly associated with PSC. A diagnosis of rPSC was made based on radiographic features, histology or both . . . To read further, please click on the title. Primary sclerosing cholangitis: One disease or several?
Christopher L. Bowlus M.D, Clinical Liver Disease Volume 3, Issue 2, pages 34–37, February 2014 Primary sclerosing cholangitis (PSC) is a heterogeneous, idiopathic, inflammatory disorder of the bile ducts frequently associated with inflammatory bowel diseases (IBD) of the colon. The first descriptions of PSC in the 1920s described an “obliterative cholangitis” of the extrahepatic biliary tree with diffuse thickening of the wall and narrowing of the lumen. In the 1960s, radiographic cholangiograms revealed the diffuse involvement of the intrahepatic and extrahepatic biliary tree in many cases, and histologic studies noted the wide range of findings on liver biopsy, from normal to the classic concentric biliary fibrosis. The diagnosis of PSC then and now relies upon these cholangiographic features of focal biliary strictures and dilations in the absence of a secondary cause of sclerosing cholangitis . . . The full text of this article is available, along with a video presentation of the article and an interview with the author. |
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December 2016
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