High-Dose Ursodeoxycholic Acid in Primary Sclerosing Cholangitis: A 5-Year Multicenter, Randomized, Controlled Study

Olsson, Rolf; Boberg, Kirsten Muri; Muckadell, Ove Schaffalitsky de; Lindgren, Stefan; Hultcrantz, Rolf; Folvik, Geir; Bell, H.; Gangsoy-Kristiansen, M.; Matre, Jon; Rydning, Andreas; Wikman, Ola; Danielsson, Åke; Sandberg-Gertzén, Hanna; Ung, Kjell-Arne; Eriksson, Anders; Lööf, Lars; Prytz, Hanne; Marschall, Hanns‐Ulrich; Broomé, Ulrika

doi:10.1053/j.gastro.2005.08.017

Cited by 348 publications

(246 citation statements)

References 34 publications

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“…Previous studies led us to believe that UDCA would be safe and beneficial (9)(10)(11)(12). Patients with primary biliary cirrhosis, in whom a dose of 13-15 mg/kg/day has been approved by the Food and Drug Administration have not had more adverse events when treated with higher doses up to 25 or 30 mg/kg/day (14).…”

Section: Discussionmentioning

confidence: 99%

High Dose Ursodeoxycholic Acid for the Treatment of Primary Sclerosing Cholangitis

Harnois¹

2010

Yearbook of Medicine

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Section: Discussionmentioning

confidence: 99%

High Dose Ursodeoxycholic Acid for the Treatment of Primary Sclerosing Cholangitis

Harnois¹

2010

Yearbook of Medicine

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“…The therapy was associated with increased risk of esophagogastric varices and mortality, suggesting a risk of high-dose UDCA therapy for patients with primary sclerosing cholangitis [100]. On the basis of variable data on its effects on liver tests and survival [100][101][102][103], UDCA therapy is not recommended in the American Association for the Study of Liver Diseases (AASLD) [104] and European Association for the Study of the Liver (EASL) [105] guidelines. We propose its careful use as a treatment option after assessment of the benefit-risk balance.…”

Section: Antifibrotic Therapymentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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“…Higher doses of UCDA (20-30 mg/kg/day) have been shown to be detrimental, rather than to have any substantial clinical benefit [72][73][74][75][76]. UCDA does not improve liver histology or liver transplant free survival, nor does it prevent the development of cholangiocarcinoma, colonic adenomas, colon cancer or incidence of death [73,[77][78][79].…”

Section: Management Of Pscmentioning

confidence: 99%

A review of liver disorders in inflammatory bowel disease (IBD)

Shah¹,

Gupta²,

Borg³

2017

Clin Case Rep Rev

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Disorders of the liver and the biliary tract are frequently the extraintestinal manifestations of inflammatory bowel disease (IBD). The etiology of these hepato-biliary conditions is deemed secondary to their shared pathogenesis, the chronic effects of a long term, ongoing inflammation of the bowels, along with the medications used to manage IBD. For up to 30% of patients with IBD, abnormal liver biochemical tests are present. Other, selected patients with IBD are followed for reactivation of hepatitis B, through guidelines only relatively recently in place. The vast realm of related clinical conditions does not always correspond well with IBD severity, which can range from mild hepatic insult to end-stage liver disease, necessitating liver transplantation. Hence it is critical to follow its presence, clinical course and long term consequences. Moreover, the management of these disorders is necessarily individualized, with some patients requiring frequent monitoring and others a more multi-disciplinary approach. Studies aimed at improving the outcomes of patients with IBD who experience associated liver and biliary tract disorders are now needed to assess early identification, possible screening approaches and more effective systems of referral. This article covers the evidence-based literature on topics detailing the co-existence of liver conditions in inflammatory bowel disease with a focus on its epidemiology, clinical manifestations, diagnosis and management.

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High-Dose Ursodeoxycholic Acid in Primary Sclerosing Cholangitis: A 5-Year Multicenter, Randomized, Controlled Study

Cited by 348 publications

References 34 publications

High Dose Ursodeoxycholic Acid for the Treatment of Primary Sclerosing Cholangitis

High Dose Ursodeoxycholic Acid for the Treatment of Primary Sclerosing Cholangitis

Evidence-based clinical practice guidelines for liver cirrhosis 2015

A review of liver disorders in inflammatory bowel disease (IBD)

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