The evolution of natural history of primary sclerosing cholangitis

Will R. Takakura, James H. Tabibian, Christopher Bowlus

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations


Purpose of review Primary sclerosing cholangitis (PSC) is a rare, idiopathic biliary disease often with an insidious onset, variable disease course, and premature death related to benign and malignant PSC-related sequelae. This review aims to discuss the epidemiology, clinical variants, and natural history of PSC, incorporating data from recent population-based studies. Recent findings PSC naturally leads to cirrhosis, cholangiocarcinoma, other hepatobiliary malignancies, dominant strictures, hepatic osteodystrophy, and bacterial cholangitis. The incidence of PSC appears to be increasing, the reasons for which are unclear. The time from diagnosis to liver transplant appears to be longer in more recent studies compared with earlier studies, suggesting a better overall prognosis than previously believed. In addition, with an increasing number of patients undergoing liver transplantation for PSC, the frequency of death because of liver failure has decreased, whereas cancer-related deaths have increased among patients with PSC. Summary PSC is a heterogeneous disease with a variety of clinical outcomes, both fatal and nonfatal. The progression of liver fibrosis in an individual patient is difficult to predict and may vary from a relatively benign, nonprogressive form to a rapidly progressive form with the need for liver transplantation.

Original languageEnglish (US)
Pages (from-to)71-77
Number of pages7
JournalCurrent Opinion in Gastroenterology
Issue number2
StatePublished - Mar 1 2017


  • Biliary Tract Disease
  • Epidemiology
  • Outcomes
  • Prognosis

ASJC Scopus subject areas

  • Gastroenterology


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