“The treatment of ulcerative colitis is not affected by the presence of primary sclerosing cholangitis,” says James Cox, MD, a gastroenterologist, an assistant professor, and the director of clinical skills development and physician communication at Burnett School of Medicine at Texas Christian University in Fort Worth. But PSC treatments can be offered alongside UC treatment.
Treatments can lessen symptoms and complications of PSC, but no options yet exist to slow it down or cure it. Some experts recommend ursodeoxycholic acid (UDCA) for PSC, a medication normally used to treat gallstones, but the research on its effectiveness for PSC is limited.
Also, UC treatments don’t reliably treat the liver, says Awoniyi. Standard UC immunosuppressants and biologics can spark healing in the intestinal lining, but rarely change PSC progression, he adds. But researchers are testing alternative approaches. “Several small studies of oral antibiotics — most notably vancomycin — show meaningful reductions in colitis activity (clinical and endoscopic) in PSC‑UC,” says Awoniyi.
Depending on your symptoms, your provider may recommend a therapeutic endoscopy. When PSC narrows your bile ducts, endoscopic treatment is used to widen your ducts with a balloon, which can not only prevent damage to the bile ducts but also offer an opportunity to take a biopsy and rule out cancer, says Dr. Cox.
PSC progresses slowly, but often ends in severe liver disease that may require liver transplantation within 15 to 20 years after diagnosis. In fact, PSC is the fifth most common reason for liver transplant in the United States. “Thus, management centers on aggressive colitis surveillance (annual colonoscopy after diagnosis), individualized use of antibiotics, and vigilant hepatobiliary monitoring rather than expecting liver benefit from conventional UC strategies,” says Awoniyi.
