Treatment of primary sclerosing cholangitis in children

作     者：Trevor J Laborda M Kyle Jensen Marianne Kavan Mark Deneau 

作者机构：Department of PediatricsUniversity of Utah 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2019年第11卷第1期

页      面：19-35页

学科分类：10[医学] 

主　　题：Liver transplant Pediatric Ursodeoxycholic acid Oral vancomycin Oral vancomycin therapy Endoscopic retrograde cholangiopancreatography 

摘      要：Primary sclerosing cholangitis(PSC) is a rare disease of stricturing and destruction of the biliary tree with a complex genetic and environmental *** patients have co-occurring inflammatory bowel disease. Children generally present with uncomplicated disease, but undergo a variable progression to endstage liver disease. Within ten years of diagnosis, 50% of children will develop clinical complications including 30% requiring liver *** is a rare but serious complication affecting 1% of *** acid and oral vancomycin therapy used widely in children as medical therapy, and may be effective in a subset of patients. Gamma glutamyltransferase is a potential surrogate endpoint for disease activity, with improved survival in patients who achieve a normal value. Endoscopic retrograde cholangiopancreatography is a necessary adjunct to medical therapy to evaluate mass lesions or dominant strictures for malignancy, and also to relieve biliary obstruction. Liver transplantation remains the only option for patients who progress to end-stage liver disease. We review special considerations for patients before and after transplant, and in patients with inflammatory bowel disease. There is presently no published treatment algorithm or guideline for the management of children with PSC. We review the evidence for drug efficacy, dosing, duration of therapy, and treatment targets in PSC, and provide a framework for endoscopic and medical management of this complex problem.