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Pericholangitis Treatment & Management

  • Author: Robert P Myers, MD, FRCPC; Chief Editor: BS Anand, MD  more...
 
Updated: Jun 22, 2016
 

Approach Considerations

No effective medical treatment exists for pericholangitis; liver transplantation is the only effective treatment. No effective preventive therapy exists for pericholangitis. Neither colectomy in patients with ulcerative colitis (UC) nor medical management of associated inflammatory bowel disease (IBD) prevents the development of pericholangitis.[13, 14, 15]

Patients with complications of end-stage pericholangitis, such as ascites, spontaneous bacterial peritonitis, portal hypertensive bleeding, and hepatic encephalopathy, should be treated like patients with other causes of chronic liver disease. Transfer patients with end-stage pericholangitis to a center specializing in liver transplantation. Failure to do so is a potential medicolegal pitfall.

A gastroenterologist should be consulted for the management of associated IBD, including screening for colorectal dysplasia and cancer. An endocrinologist and a metabolism specialist should be consulted for the management of associated osteopenia or osteoporosis.

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Pharmacologic and Supplemental Therapy

Several medications, including penicillamine, colchicine, corticosteroids, azathioprine, methotrexate, nicotine, and pentoxifylline, have been tried for primary sclerosing cholangitis (PSC) and have proved ineffective, though they have not been specifically tested in patients with pericholangitis.[16, 17, 18] Ursodeoxycholic acid may have a role in this disorder.

For patients with documented deficiencies of fat-soluble vitamins (ie, A, D, E, or K), initiate vitamin replacement. For patients who are osteopenic, prescribe calcium (>1000 mg/day) and vitamin D (800 IU/day).

Patients who are osteoporotic should receive bisphosphonate therapy. These agents can cause esophageal irritation when taken orally, which raises concerns about their safety in patients with esophageal varices. Patients with documented esophageal varices probably should receive intermittent intravenous (IV) infusions of bisphosphonates such as pamidronate.

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Liver Transplantation

Liver transplantation is the only proven effective treatment for PSC. Preliminary evidence suggests that patients with late pericholangitis also do well with liver transplantation. Most series have reported a dismal prognosis for liver transplantation if cholangiocarcinoma is present, and these results discourage transplantation in this situation.

Compared with patients who undergo liver transplantation for other indications, patients with PSC seem to have a higher incidence of chronic ductopenic rejection after transplant surgery. Large-duct PSC recurs in approximately 20% of liver allografts. Recurrence of pericholangitis has yet to be reported.

Those with long-standing IBD should undergo surveillance colonoscopy every 1-2 years. Patients with IBD who have received a liver transplant for pericholangitis may be at increased risk as a consequence of the effects of immunosuppression. They require more intense colonoscopic surveillance.

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Contributor Information and Disclosures
Author

Robert P Myers, MD, FRCPC Assistant Professor, Director, Viral Hepatitis Clinic, Division of Gastroenterology, Department of Medicine, University of Calgary Faculty of Medicine, Canada

Robert P Myers, MD, FRCPC is a member of the following medical societies: American Association for the Study of Liver Diseases, Royal College of Physicians and Surgeons of Canada, Canadian Association of Gastroenterology

Disclosure: Nothing to disclose.

Coauthor(s)

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, Royal College of Physicians and Surgeons of the United States, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Radiologists, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Noel Williams, MD Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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