In order to make a clear diagnosis of primary sclerosing cholangitis, further diagnostic measures must be taken in addition to detailed questioning (anamnesis) and physical examination (jaundice? pressure pain?). In addition to blood tests in the laboratory, an ultrasound examination of the liver and gallbladder is the first step.
During this painless examination, high-frequency ultrasound waves are used to create a visual image of our internal organs. However, since the affected bile ducts are very small, they cannot be directly shown with an ultrasound examination. However, it is possible to detect without problems the accumulation of bile caused by the primary sclerosing cholangitis!
In order to further narrow down the diagnosis, a special form of MRI examination, MRCP, can be performed. In this MRI examination, patients are placed in the tubular MRI machine for a short time. Using magnetic waves of certain orientations, detailed images of the liver with its small bile ducts can be produced, so that the diagnosis “primary sclerosing cholangitis” can be assured in the vast majority of cases.
Unfortunately there is still no curative treatment for primary sclerosing cholangitis. Only liver transplantation represents a definitive chance of cure. In order to keep the liver values stable as long as possible and to avoid possible infections, various drugs can be used.
Urodesoxycholic acid”, or UDCS for short, has a long tradition in treatment. It has been proven to improve liver values and often leads to a reduction in itching and jaundice. The drug is also under discussion as a means of reducing the risk of bile duct cancer in patients.
To prevent acute and painful inflammation of the bile ducts (cholangitis), patients must also take antibiotics occasionally. If the bile ducts become significantly narrower (stenosis), the development of gallstones is promoted. In order to “widen” such narrowing again and to further ensure the flow of bile, so-called “ERCP” treatment is sometimes necessary.
As in a gastroscopy, a small tube with a camera is inserted through the mouth and advanced to the bile ducts. Possible constrictions, but also smaller gallstones can be removed directly during ERCP. Meanwhile, the patient sleeps and thanks to sedatives feels nothing.
Cirrhosis of the liver
Cirrhosis of the liver is the final stage of advanced liver disease. Original liver tissue is increasingly replaced by connective tissue, so that our important organ can no longer fulfil its tasks. Liver damage caused in this way can in most cases no longer be reversed. Untreated, even primary sclerosing cholangitis can develop into cirrhosis of the liver and cause life-threatening complications. These include bleeding, brain disease or kidney damage.
Those affected by primary sclerosing cholangitis have a significantly increased risk of developing colon cancer (colon cancer) during their lifetime. In comparison with the normal population, experts even name an approximately 10-fold increased probability. To detect colon cancer as early as possible, colonoscopies should be performed at regular intervals. In this way preliminary stages of the cancer, so-called polyps, can usually be removed during the examination. However, bile duct carcinomas (CCC) occur even more frequently!