Article Text

Download PDFPDF
PSC: Protect and Serve with Colitis: does it help the liver to have severe ulcerative colitis?
  1. Christian Rust,
  2. Stephan Brand
  1. Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
  1. Correspondence to Dr Christian Rust, Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistrasse 15, D-81377 Munich, Germany; christian.rust{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic disease of unknown aetiology affecting the biliary tree. It is characterised by bile duct inflammation and fibrosis, and in many patients it progresses to biliary cirrhosis and hepatic failure necessitating liver transplantation. A unique feature of PSC is its strong association with inflammatory bowel disease (IBD). In fact, at least 70% of patients with PSC also suffer from IBD, most commonly ulcerative colitis (UC). Conversely, only 2.5–7.5% of patients with IBD will develop PSC. Although this association has been known since 1965,1 the underlying pathophysiology is still unknown. Despite this lack of fundamental information, hepatologists in clinical day-to-day business often note that patients with PSC are seldom troubled by severe UC. Are these just individual observations or does a common scheme exist?

Surprisingly, there are only a few studies addressing this issue. Patients with PSC with IBD seem to have a higher prevalence of pancolitis with rectal sparing and back-wash ileitis.2 In this study, a lower rate of colectomies was noted in patients with PSC/UC as compared with patients with UC, suggesting a milder course of colitis in the PSC/UC group. Indeed, UC may have a long subclinical course in patients with PSC, as shown in a small Swedish cohort.3 …

View Full Text


  • Linked article 235408.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles