Primary sclerosing cholangitis secondary prevention: Difference between revisions

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==Overview==
==Overview==
Secondary prevention in patients with primary sclerosing cholangitis is aimed at screening for complications and coexisting conditions in these patients. These include screening for complications of [[liver cirrhosis]], screening for [[colon]] and [[gallbladder]] [[cancers]], as well as metabolic bone disease.


==Secondary Prevention==
==Secondary Prevention==
Secondary prevention in patients with primary sclerosing cholangitis is aimed at screening for complications and coexisting conditions in these patients. These include:
Secondary prevention in patients with primary sclerosing cholangitis is aimed at screening for complications and coexisting conditions in these patients. These include:<ref name="pmid27653566">{{cite journal |vauthors=Lazaridis KN, LaRusso NF |title=Primary Sclerosing Cholangitis |journal=N. Engl. J. Med. |volume=375 |issue=12 |pages=1161–70 |year=2016 |pmid=27653566 |doi=10.1056/NEJMra1506330 |url=}}</ref><ref name="pmid20101749">{{cite journal |vauthors=Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ |title=Diagnosis and management of primary sclerosing cholangitis |journal=Hepatology |volume=51 |issue=2 |pages=660–78 |year=2010 |pmid=20101749 |doi=10.1002/hep.23294 |url=}}</ref><ref name="pmid27330336">{{cite journal |vauthors=Kumar A, Wheatley D, Puttanna A |title=Primary Sclerosing Cholangitis: Therapeutic Options and Surveillance Management |journal=Clin Med Insights Gastroenterol |volume=9 |issue= |pages=25–9 |year=2016 |pmid=27330336 |pmc=4902039 |doi=10.4137/CGast.S38451 |url=}}</ref>
<small></small>
{| class="wikitable"
{| class="wikitable"
!Complication/ Coexisting Condition
! align="center" style="background: #4479BA; color: #FFFFFF; " |Complications/ Coexisting Conditions
!Presentation
! align="center" style="background: #4479BA; color: #FFFFFF; " |Presentation
!Screening
! align="center" style="background: #4479BA; color: #FFFFFF; " |Screening
!Management
! align="center" style="background: #4479BA; color: #FFFFFF; " |Management
|-
|-
|[[Liver Cirrhosis]]
| style="background:#DCDCDC;" |[[Liver Cirrhosis]]
|
|
* [[Esophageal varices]], [[gastric varices]]
* [[Esophageal varices]], [[gastric varices]]
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* Screen for [[HCC]] using an annual [[abdominal]] [[ultrasound]] with or without measuring [[alpha fetoprotein]] ([[AFP]]) levels.  
* Screen for [[HCC]] using an annual [[abdominal]] [[ultrasound]] with or without measuring [[alpha fetoprotein]] ([[AFP]]) levels.  
|
|
* If there are no [[varices]], observe the patient and continue screening with repeat [[EGD]]. For small [[varices]], treat with [[Nadolol (tablet)|nadolol]] (40 mg, given once daily at bedtime). For large [[varices]], treat with [[ligation]].
* [[HCC]]: [[HCC]] is treated with [[ablation]], [[resection]] or [[liver transplantation]].
|-
|-
| style="background:#DCDCDC;" |[[Gallbladder]] disease
|
|
* [[Polyps]]/ masses
|
|
* [[Abdominal]] [[ultrasound]]
|
|
* Consider prophylactic [[cholecystectomy]] in patients with [[gallbladder]] [[polyps]] and masses, due to high risk of [[carcinoma]].
* [[Chemotherapy]] is added if there is evidence of [[gallbladder]] [[cancer]] extending beyond the wall of the [[gallbladder]].
|-
| style="background:#DCDCDC;" |[[IBD]] and associated risk of [[colon cancer]]
|
* [[Colon cancer]]
|
* [[Colonoscopy]] annually
|
|
* In case of [[colon cancer]], treat with [[colectomy]].
* [[Chemotherapy]] is added to treatment regimen according to guidelines of the treatment of [[colon cancer]].
|-
|-
| style="background:#DCDCDC;" |Metabolic bone disease
|
|
* [[Osteopenia]]/ [[osteoporosis]]
|
|
* [[DEXA scan]]. Repeat every 2-3 years.
|
|
|
* For [[osteopenia]] and [[osteoporosis]], treat with [[calcium]] 1.0-1.5 g/day and [[vitamin D]] of 1,000 IU/day.
|}
* Add [[bisphosphonates]] in the case of [[osteoporosis]].
|}<small>
==References==


==References==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 17:27, 6 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

Secondary prevention in patients with primary sclerosing cholangitis is aimed at screening for complications and coexisting conditions in these patients. These include screening for complications of liver cirrhosis, screening for colon and gallbladder cancers, as well as metabolic bone disease.

Secondary Prevention

Secondary prevention in patients with primary sclerosing cholangitis is aimed at screening for complications and coexisting conditions in these patients. These include:[1][2][3]

Complications/ Coexisting Conditions Presentation Screening Management
Liver Cirrhosis
Gallbladder disease
IBD and associated risk of colon cancer
Metabolic bone disease

References

  1. ↑ Lazaridis KN, LaRusso NF (2016). "Primary Sclerosing Cholangitis". N. Engl. J. Med. 375 (12): 1161–70. doi:10.1056/NEJMra1506330. PMID 27653566.
  2. ↑ Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ (2010). "Diagnosis and management of primary sclerosing cholangitis". Hepatology. 51 (2): 660–78. doi:10.1002/hep.23294. PMID 20101749.
  3. ↑ Kumar A, Wheatley D, Puttanna A (2016). "Primary Sclerosing Cholangitis: Therapeutic Options and Surveillance Management". Clin Med Insights Gastroenterol. 9: 25–9. doi:10.4137/CGast.S38451. PMC 4902039. PMID 27330336.

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