Primary Sclerosing Cholangitis (PSC) is a chronic autoimmune liver disease in which your immune system mistakenly attacks the bile ducts. Over time, inflammation and scarring narrow these ducts, blocking the flow of bile from the liver to the intestines. This progressive damage can lead to cholestasis, cirrhosis and, in advanced cases, liver failure. PSC most often affects larger intrahepatic and extrahepatic bile ducts and is frequently associated with ulcerative colitis.
PSC often develops slowly, and you may not notice problems until the disease is advanced. When symptoms do appear, they can include:
The exact cause of PSC remains unknown, but several factors appear to increase risk:
If you suspect Primary Sclerosing Cholangitis or need expert management of your PSC, book an appointment today with our specialists at GastroDoxs in Houston. We offer patient-centered care, advanced diagnostics, and personalized treatment plans to help you manage symptoms, slow disease progression, and improve your quality of life.
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No. Primary Biliary Cholangitis (PBC) mainly affects the small bile ducts and is more common in women. Primary Sclerosing Cholangitis (PSC) generally involves larger bile ducts and occurs more often in men.
PSC diagnosis typically involves a combination of liver blood tests, MRCP (Magnetic Resonance Cholangiopancreatography) imaging, endoscopic evaluation of the bile ducts (ERCP), and sometimes a liver biopsy to confirm scarring and rule out other causes.
The leading risk factors include having ulcerative colitis or another inflammatory bowel disease, certain genetic predispositions, and the presence of specific autoantibodies (such as pANCA) that suggest immune-mediated bile duct injury.
Yes. PSC significantly raises the risk of developing cholangiocarcinoma (bile duct cancer) and, over time, may increase the likelihood of hepatocellular carcinoma (primary liver cancer), particularly in advanced disease.
While there is no cure, treatments can slow progression and relieve symptoms. Options include ursodeoxycholic acid (UDCA) to improve liver tests, endoscopic bile duct dilation, antibiotics for infections, and ultimately liver transplantation for end-stage disease.
The pANCA (perinuclear anti-neutrophil cytoplasmic antibody) test helps support a PSC diagnosis by identifying autoantibodies commonly seen in PSC patients and helps differentiate PSC from other cholestatic liver diseases.
You should schedule an evaluation if you experience persistent fatigue, unexplained jaundice, itching, right upper-quadrant abdominal pain, or abnormal liver function tests to determine if PSC or another liver condition is present.
Regular follow-up every 3-6 months is recommended, including blood tests and imaging as needed. If you have ulcerative colitis, an annual colonoscopy is also advised to monitor for colonic complications.
To support liver health, avoid alcohol, follow a balanced diet low in saturated fats, stay physically active, maintain a healthy weight, and keep up with vaccinations (hepatitis A and B, flu, and pneumonia).
Currently, there is no cure for PSC. However, with early detection, regular monitoring, and appropriate interventions-up to and including liver transplantation in advanced cases-most patients can manage symptoms and maintain quality of life.
