The medical management of primary sclerosing cholangitis

Primary sclerosing cholangitis raises several challenges for the physician. These include the identification of a drug regimen that slows or reverses the progression of the disease, the effective management of the symptoms of cholestasis, and the prevention of complications of the disease, including the development of colorectal cancer. The most studied drug in PSC is ursodeoxycholic acid, which, despite a range of potentially valuable actions on the cholestatic liver, has not yet been proven to make a substantial change in the course of the disease. However, it may yet prove to be sufficiently effective in the prevention of colorectal neoplasia to be prescribable for this reason alone. Better progress has been made in identifying agents that can alleviate pruritus and prevent the progression of osteopenia.