Treatment

Therapy with cholestyramine may help control symptoms of pruritus, and antibiotics are useful when cholangitis complicates the clinical picture. Vitamin D and calcium supplementation may help prevent the loss of bone mass frequently seen in patients with chronic cholestasis. Glucocorticoids, methotrexate, and cyclosporine have not been shown to be efficacious. UDCA improves serum liver tests, but an effect on survival has not been documented. In cases where complete or high-grade biliary obstruction (dominant strictures) has occurred, balloon dilatation, stenting, or (rarely) surgical intervention may be appropriate. Efforts at biliary-enteric anastomosis or stent placement may, however, be complicated by recurrent cholangitis and further progression of the stenosing process. The role of colectomy in patients with sclerosing cholangitis complicating chronic ulcerative colitis is uncertain. The prognosis is unfavorable, with a median survival of 9 to 12 years following the diagnosis, regardless of therapy. Four variables (age, serum bilirubin level, histologic stage, and splenomegaly) predict survival in patients with primary sclerosing cholangitis and serve as the basis for a risk score. Primary sclerosing cholangitis is one of the most common indications for liver transplantation.

In two large studies involving 627 and 3147 patients, the prevalence of gallbladder polyps was 6.7 and 6.9%, respectively, with a marked male predominance. Few significant changes occurred over a 5-year period in asymptomatic patients in whom gallbladder polyps 10 mm in diameter were found. If polyps 10 mm are present and show rapid growth, cholecystectomy should be considered.

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