Therapies for Primary Sclerosing Cholangitis: Vancomycin as a Novel Treatment Option

Sukhpreet Singh, Kusum K. Kharbanda

Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska 68105, USA. Department of Internal Medicine and Department of Biochemistry & Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA

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Primary sclerosing cholangitis (PSC) is a disease of the bile ducts that causes inflammation and destruction of the intra- and/or extra-hepatic bile ducts. It is also a progressive disorder that leads to fibrosis and liver failure, and increases the risk of malignancy. PSC is a heterogeneous disease that is often associated with inflammatory bowel disease (IBD), mainly ulcerative colitis (UC). As of now, there is no established medical therapy for PSC and many patients will eventually require liver transplantation. PSC is the fifth leading cause for liver transplantation, but transplantation does not guarantee a cure since there is a 20% chance of disease recurrence in the graft. At present the mainstay of therapy is Ursodeoxycholic acid (UDCA) which has largely been studied in various randomised control trials but has failed to alter the long-term outcome and natural course of the disease. Pathogenesis of PSC is still not clearly understood but recent advances have paved way for trial of new therapeutic agents. Here in this review article, we present information gathered from published case reports/series and randomised control trials on the relationship between the microbiota and PSC pathogenesis with a purpose of understanding whether vancomycin is a potential effective pharmacotherapy for patients with this disease. Journal of Nature and Science (JNSCI), 3(9):e440, 2017

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