Primary sclerosing cholangitis
ICD-10 K83.0 · ICD-11 DB96.2

Primary sclerosing cholangitis with concomitant inflammatory bowel disease

Patients with primary sclerosing cholangitis (PSC) frequently have co-existing inflammatory bowel disease (IBD). This combination requires careful, coordinated management: the IBD itself must be treated to the standard of current guidelines, with the specific goal of achieving mucosal healing.

Clinical scenario
PSC occurring alongside inflammatory bowel disease. Treatment of PSC-related IBD in line with current practice guidelines, with the goal of achieving mucosal healing, is recommended.
Surgical management — approach
When colonic disease reaches certain thresholds — including high-grade dysplasia, neoplasia, or symptomatic colitis that has not responded to optimum medical therapy — a surgical intervention involving colectomy is recommended. The specific indications, procedure type, and decision pathway are detailed in the full protocol…
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References

Treatment of PSC-related IBD in line with current practice guidelines with the goal of achieving mucosal healing is recommended.

Colectomy is recommended in patients with high-grade colonic dysplasia or neoplasia or if symptomatic colonic inflammatory activity persists despite optimum medical therapy.

Total proctocolectomy is recommended in the case of high-grade dysplasia or adenocarcinoma or non-adenoma-like dysplastic lesions of any grade due to the high risk for concomitant and future colorectal carcinoma, and also if symptomatic colonic inflammatory activity persists despite optimum medical therapy.

DOI: 10.1016/j.jhep.2022.05.011

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