Bile acids for primary sclerosing cholangitis

Chen, Wendong; Gluud, Christian

doi:10.1002/14651858.cd003626

Cited by 26 publications

(16 citation statements)

References 45 publications

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“…Although the three major studies all showed decreases in liver enzyme levels with UDCA, they failed to demonstrate any improvement in symptoms or liver histology [46][47][48] . In a meta-analysis by Chen [49] , no difference was observed between UDCA and placebo regarding overall survival and disease progression with the development of complications, requiring transplantation. UDCA also did not prevent deterioration of histological or cholangiographic findings.…”

Section: Medical Treatment Of Pscmentioning

confidence: 98%

Primary sclerosing cholangitis - What is the difference between east and west?

Shorbagi¹,

Bayraktar²

2008

WJG

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Primary sclerosing cholangitis (PSC) is a chronic, progressive, cholestatic liver disease characterized by inflammation and fibrotic obliteration of the hepatic biliary tree. It is commonly associated with inflammatory bowel disease (IBD). A number of complications can occur which require special consideration, the most important of which is the development of cholangiocellular carcinoma (CCC). Unfortunately, no medical therapy is currently available for the underlying liver disease. Liver transplantation is an effective, lifeextending option for patients with advanced PSC. Geographical variations between East and West include a second peak for age with a lower association with IBD in a Japanese population and female predominance in a lone study from Turkey. The clinical and biochemical Mayo criteria may not be universally applicable, as different patients show variations regarding the initial presentation and natural course of the disease. Directing research towards explaining these geographical differences and understanding the pathogenesis of PSC is required in order to develop better therapies for this devastating disease.

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Section: Medical Treatment Of Pscmentioning

confidence: 98%

Primary sclerosing cholangitis - What is the difference between east and west?

Shorbagi¹,

Bayraktar²

2008

WJG

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“…UDCA does not cure cholestasis, or liver disease [8,156,173,174]. UDCA properties promise a class of its own as a transient anti-metabolite, and a tumor suppressive agent.…”

Section: Udca As a Medicinementioning

confidence: 99%

Molecular Mechanisms of Ursodeoxycholic Acid Toxicity & Side Effects: Ursodeoxycholic Acid Freezes Regeneration & Induces Hibernation Mode

Kotb

2012

IJMS

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Ursodeoxycholic acid (UDCA) is a steroid bile acid approved for primary biliary cirrhosis (PBC). UDCA is reported to have “hepato-protective properties”. Yet, UDCA has “unanticipated” toxicity, pronounced by more than double number of deaths, and eligibility for liver transplantation compared to the control group in 28 mg/kg/day in primary sclerosing cholangitis, necessitating trial halt in North America. UDCA is associated with increase in hepatocellular carcinoma in PBC especially when it fails to achieve biochemical response (10 and 15 years incidence of 9% and 20% respectively). “Unanticipated” UDCA toxicity includes hepatitis, pruritus, cholangitis, ascites, vanishing bile duct syndrome, liver cell failure, death, severe watery diarrhea, pneumonia, dysuria, immune-suppression, mutagenic effects and withdrawal syndrome upon sudden halt. UDCA inhibits DNA repair, co-enzyme A, cyclic AMP, p53, phagocytosis, and inhibits induction of nitric oxide synthatase. It is genotoxic, exerts aneugenic activity, and arrests apoptosis even after cellular phosphatidylserine externalization. UDCA toxicity is related to its interference with drug detoxification, being hydrophilic and anti-apoptotic, has a long half-life, has transcriptional mutational abilities, down-regulates cellular functions, has a very narrow difference between the recommended (13 mg/kg/day) and toxic dose (28 mg/kg/day), and it typically transforms into lithocholic acid that induces DNA strand breakage, it is uniquely co-mutagenic, and promotes cell transformation. UDCA beyond PBC is unjustified.

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“…1,2 Here we describe patients with PSC associated with ulcerative colitis (UC) having biochemical and/or histological improvement of their liver disease following administration of sulfasalazine (SASP). There was a case report describing that the combination therapy with SASP and ursodeoxycholic acid (UDCA) was useful for three PSC children.…”

Section: Therapeutic Benefit Of Sulfasalazine For Patients With Primamentioning

confidence: 99%