Expertise in Managing Patients with PSC and IBD

If you have both primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD), you may have no symptoms or mild symptoms even if your diseases are causing damage in your body. That is why you should seek expert care from a team that has extensive experience managing both conditions.

Because of our robust IBD Center and Center for Liver Diseases at the University of Chicago Medicine, we see a high volume of patients with PSC and IBD. That means we have more experience managing these patients’ complex care needs.

What is the connection between PSC and IBD?

PSC is a chronic liver disease that is strongly associated with IBD. Nine out of 10 patients with PSC also have a form of IBD: ulcerative colitis or Crohn’s disease. Yet only about 5 percent of IBD patients also have PSC.

People with PSC and IBD typically have inflammation throughout their colon and have a higher risk for precancerous changes in the colon and colon cancer. They also have a higher risk for developing bile duct and gallbladder cancers.

Our Treatment Approach to PSC and IBD

We understand that having both PSC and IBD can be especially debilitating. At UChicago Medicine, we offer a comprehensive, multidisciplinary treatment approach that includes hepatologists (liver specialists), IBD specialists, colorectal and liver surgeons, radiologists and pathologists. Our team works together to personalize your care.

Frequently Asked Questions about PSC and IBD

If you have PSC, you should be checked for IBD because it is so common in people with PSC. This will likely involve several tests, including blood and stool tests, imaging, and a colonoscopy with biopsies (tissue sample).

It’s much less common for people with IBD to also have PSC. But if you have IBD, you may have liver function tests (LFTs) to determine if you have PSC. If your LFTs are abnormal, you should see a hepatologist for an evaluation.

If you have PSC and IBD (especially ulcerative colitis), you have a higher risk for developing colon cancer. That is why it is recommended that you have a yearly colonoscopy to check for precancerous changes or cancer in the colon.

You also are at higher risk for developing bile duct and gallbladder cancers, so you will need magnetic resonance cholangiopancreatography (MRCP) imaging tests at least once a year. An MRCP can check your liver, bile ducts, gallbladder and pancreas for cancer.

And because you have a higher risk for osteoporosis, you should get regular bone density tests. PSC patients are also at risk for fat-soluble vitamin malabsorption and need their vitamin A, D and E levels checked on a regular basis.

There is no single, proven treatment for people with PSC and IBD. Most patients with IBD and PSC require maintenance treatment for their IBD. Our team will tailor a therapeutic approach based on your clinical history, disease activity and symptoms. Researchers at UChicago Medicine are currently studying multiple treatment options through clinical trials for certain patients.

Eating a healthy diet and avoiding alcohol can also help manage your PSC and IBD symptoms. Managing stress may also be helpful if you have PSC and IBD. To help with these lifestyle changes, our team includes a clinical psychologist and dietitian who specialize in treating patients with digestive diseases.

Some people with PSC and IBD may be candidates for liver transplant, which is available for eligible patients at UChicago Medicine. When you work with our team, we can provide early evaluation for living donor liver transplant. This may help you receive a transplant more quickly.

In addition, some patients with IBD and PSC who do not respond to IBD medications or who have developed precancerous changes in the colon or colon cancer require surgery on their colon.

Our IBD and liver specialists work closely with our colorectal surgeons and transplant surgeons to design the most effective treatment plan for you.

It is not clear why people with PSC and IBD and prone to liver scarring, bowel inflammation and the development of colon cancer. Researchers at UChicago Medicine are investigating the interaction between environmental triggers, the immune system and the gut microbiome (the living organisms in the digestive tract) to help understand the connection between PSC and IBD. Their studies also aim to identify targets for treatment.