IBD + SCLEROSING CHOLANGITIS INCREASES CANCER RISK

We may not know why those with ulcerative colitis or Crohn's disease in their large intestine, especially the in the right side of their intestine are more likely to get sclerosing cholangitis (also called primary sclerosing cholangitis or PSC), but we do know that those with PSC and inflammatory bowel disease (IBD) are often harder to treat and at 2 – 4 times the risk for getting colon cancer.  

What is PSC?

Primary sclerosing cholangitis is narrowing of the bile ducts that normally deliver bile into the small intestine to help digest foods, fatty foods in particular. The narrowing comes inflammation and scarring of the bile ducts. The inflammation is thought come from an autoimmune reaction on the bile ducts, that can come with ulcerative colitis more often than Crohn's disease, and more often in males than females. 

Often, the first clue comes from abnormal liver tests that are found with routine blood work done to monitor IBD treatments. The next clue comes when ultrasounds and other scans are performed. Those can show narrowing along the bile ducts. These abnormalities may be seen even before someone has been shown to have IBD.

If the PSC progresses, symptoms may develop, including 

• Fever and chills
• Itching (can be severe)
• Jaundice (yellowing of the skin and eyes)
• A large liver and sometimes a large spleen
• Pain and tenderness on the right side where the liver sits
• Nausea, poor appetite and weight loss

Sometimes these problems can show up even when they seem to be fine (in clinical remission) with their IBD. But often, these patients will show active disease in the intestine when checked with stool tests (calprotectin) or colonoscopy. And they should be checked regularly, because they are 2 – 4 times more likely to develop colon cancer.

Treatment for PSC and IBD Together

Treatment for IBD should continue, especially because there is often unrecognized disease activity. But the treatment may change to a more effective medicine or a medicine that has less potential for injury to the liver.

Treatment for the PSC is often to relieve the symptoms and effects of the PSC

• Ursodeoxycholic acid to help the bile flow through the bile ducts
• Bile-binding agents that hold onto the bile once it gets into the intestinal track to make sure it is eliminated
• Antibiotics if fevers suggest an infection has developed 
• Vitamin A, D, E, K because they may not be absorbed well
• Pancreatic enzyme replacement therapy, if there's evidence the pancreatic duct is involved.

If PSC progresses, resulting in poor liver function, a liver transplant may be needed.