Primary sclerosing cholangitis secondary prevention

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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]

Secondary Prevention

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

Complications/ Coexisting Condition	Presentation	Screening	Management
Liver Cirrhosis	Esophageal varices, gastric varices Hepatocellular carcinoma (HCC)	Screen for varices by an esophagogastroduodenoscopy (EGD). Repeat every 2-3 years. 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 (40 mg, given once daily at bedtime). For large varices, treat with ligation. HCC: HCC is treated with ablation, resection or liver transplantation.
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.
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.
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.