What Is Primary Sclerosing Cholangitis?

Primary sclerosing cholangitis (PSC) is a long-term disease that affects the bile ducts. These small tubes carry bile from the liver to the digestive system to help break down fats.

With PSC, the bile ducts become inflamed and scarred. Over time, the ducts narrow or become blocked, causing bile to build up in the liver. This can slowly damage the liver and may lead to serious complications if not treated or monitored carefully.

The exact cause of PSC is not fully understood. Experts believe the condition may involve the immune system, genetics, and environmental factors. PSC is also closely linked to inflammatory bowel disease, especially ulcerative colitis.

Symptoms

PSC symptoms often develop gradually. Some people may not notice symptoms for years, while others experience problems that slowly worsen over time.

Common symptoms may include:

• Ongoing fatigue
• Itchy skin
• Pain or discomfort in the upper abdomen
• Yellowing of the skin or eyes (jaundice)
• Fever or chills caused by infection
• Unexplained weight loss

How Is It Diagnosed?

Healthcare providers use several tests to diagnose PSC and evaluate liver health. Blood tests can show signs of liver inflammation or damage.

Imaging tests are commonly used to look at the bile ducts. Magnetic resonance cholangiopancreatography (MRCP) is often the main imaging study because it creates detailed pictures without surgery. In some cases, providers may also use ultrasound, ERCP, or a liver biopsy to gather more information.

Your care team may also monitor vitamin levels and bone health because PSC can affect nutrient absorption and increase the risk of osteoporosis.

How Is It Treated?

There is currently no cure for PSC, but treatment can help manage symptoms and reduce complications.

Early treatment may include medications to relieve itching, treat infections, and support vitamin levels. If bile ducts become severely narrowed, procedures such as ERCP may help improve bile flow by opening blocked areas.

Regular monitoring is an important part of care. Providers may recommend screenings for liver complications, colon health, and bone density changes. Healthy lifestyle habits, including staying active, eating nutritious foods, and avoiding alcohol, can also support liver health.

For advanced PSC that leads to liver failure, a liver transplant may become the best treatment option. Many people do well after transplant surgery.