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Review
, 11 (1), 19-36

Treatment of Primary Sclerosing Cholangitis in Children

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Review

Treatment of Primary Sclerosing Cholangitis in Children

Trevor J Laborda et al. World J Hepatol.

Abstract

Primary sclerosing cholangitis (PSC) is a rare disease of stricturing and destruction of the biliary tree with a complex genetic and environmental etiology. Most patients have co-occurring inflammatory bowel disease. Children generally present with uncomplicated disease, but undergo a variable progression to end-stage liver disease. Within ten years of diagnosis, 50% of children will develop clinical complications including 30% requiring liver transplantation. Cholangiocarcinoma is a rare but serious complication affecting 1% of children. Ursodeoxycholic acid and oral vancomycin therapy used widely in children as medical therapy, and may be effective in a subset of patients. Gamma glutamyltransferase is a potential surrogate endpoint for disease activity, with improved survival in patients who achieve a normal value. Endoscopic retrograde cholangiopancreatography is a necessary adjunct to medical therapy to evaluate mass lesions or dominant strictures for malignancy, and also to relieve biliary obstruction. Liver transplantation remains the only option for patients who progress to end-stage liver disease. We review special considerations for patients before and after transplant, and in patients with inflammatory bowel disease. There is presently no published treatment algorithm or guideline for the management of children with PSC. We review the evidence for drug efficacy, dosing, duration of therapy, and treatment targets in PSC, and provide a framework for endoscopic and medical management of this complex problem.

Keywords: Endoscopic retrograde cholangiopancreatography; Liver transplant; Oral vancomycin; Oral vancomycin therapy; Pediatric; Ursodeoxycholic acid.

Conflict of interest statement

Conflict-of-interest statement: The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Endoscopic and medical management algorithm for pediatric primary sclerosing cholangitis. 1consider CA 19-9 and abdominal ultrasound every 6-12 mo for all patients over 15 and surveillance colonoscopy every 1-2 yr for patients with primary sclerosing cholangitis-inflammatory bowel disease.

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