Guest guest Posted February 9, 2004 Report Share Posted February 9, 2004 Thanks for your replies, and Steve. While I accept the possible advantages of Urso for early and mid stage treatment of PSC, especially for those patients with UC, I continue to be puzzled as to why someone like me, with end stage liver disease and without UC, would continue to take it. I say this because of Urso's effect on bilirubin and hence on my MELD score. Are there others on this list with end stage PSC who have stopped taking Urso because of this? Steve, do you care to elaborate on how you think the MELD system has built in biases against PSC patients? Best Wishes, Shauna (AIH, PSC, Crohn's Disease, pre-transplant (MELD =17)) > Hi Shauna; > > I don't know about the value of ursodiol in end-stage PSC. In end- > stage PBC (primary biliary cirrhosis) there is evidence that ursodiol > is not effective .... ursodiol delays liver fibrosis and the need for > transplantation only when given early in the course of the disease. > > In PBC there is no evidence that prior ursodiol treatment negatively > influenced post-transplant survival; rather, prior ursodiol treatment > may significantly reduce rejection. > > Assuming that early in the disease, serum alanine aminotransfrease > (ALT) and serum aspartate aminotransferase (AST) reflect liver cell > damage, and release of these proteins from the liver cells into the > blood stream, then if ursodiol is lowering these enzyme levels, does > this not mean that there is less liver cell damage with ursodiol > treatment? Protection against liver cell damage could be particularly > important in the early stages of the disease. > > Because the vast majority of patients with PSC also have ulcerative > colitis and a greatly elevated risk of colorectal cancer, the > protective effects of ursodiol against colon cancer cannot be easily > dismissed for most PSC patients. > > Best regards, > > Dave > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2004 Report Share Posted February 9, 2004 > Hi Shauna; > > I don't know about the value of ursodiol in end-stage PSC. In end- > stage PBC (primary biliary cirrhosis) there is evidence that ursodiol > is not effective .... ursodiol delays liver fibrosis and the need for > transplantation only when given early in the course of the disease. > > In PBC there is no evidence that prior ursodiol treatment negatively > influenced post-transplant survival; rather, prior ursodiol treatment > may significantly reduce rejection. > > Assuming that early in the disease, serum alanine aminotransfrease > (ALT) and serum aspartate aminotransferase (AST) reflect liver cell > damage, and release of these proteins from the liver cells into the > blood stream, then if ursodiol is lowering these enzyme levels, does > this not mean that there is less liver cell damage with ursodiol > treatment? Protection against liver cell damage could be particularly > important in the early stages of the disease. > > Because the vast majority of patients with PSC also have ulcerative > colitis and a greatly elevated risk of colorectal cancer, the > protective effects of ursodiol against colon cancer cannot be easily > dismissed for most PSC patients. > > Best regards, > > Dave > I can't really get from my daughter's doctor what is considered early stage of the disease. Is it the first year, the first 5 years? The doctor (MCV Hepatology in Richmond, VA) is talking about very high dose Urso which my daughter doesn't tolerate well. Her first major symptoms began in April of last year. How long she has been sick we don't know. So if Urso doesn't seem to do much why is it used so commonly? Just trying to do anything doesn't seem to me to be a good course. Lawrence G. Leichtman, MD PO Box 4548 Virginia Beach, VA 23454 www.lleichtman.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2004 Report Share Posted February 9, 2004 Lawrence, I'm assuming that your daughter's dx was made upon examination of liver biopsy? If so, the pathologist's report should reference the disease stage, as that's how the staging hierarchy is applied. If you'll look back a few days in the posts here, you'll find where I posted information from the s Hopkins site that explains what findings equate to which stage. If you can't find it, let me know and I'll re-post or send it to you.Steve Rahn PSC '80, L Tx 9/6 & 9/8 '85 (Wash U. - St. Louis) Recurrent PSC '02,(re)Born on the 4th of July, 2003(U of Iowa) "Face the worst; Expect the Best; Do the most, Forget the rest." -- _______________________________________________Get your free email from http://www.iname.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2004 Report Share Posted February 9, 2004 > Lawrence, > > I'm assuming that your daughter's dx was made upon examination of > liver biopsy? If so, the pathologist's report should reference the > disease stage, as that's how the staging hierarchy is applied. If > you'll look back a few days in the posts here, you'll find where I > posted information from the s Hopkins site that explains what > findings equate to which stage. If you can't find it, let me know and > I'll re-post or send it to you. > Steve Rahn > PSC '80, L Tx 9/6 & 9/8 '85 (Wash U. - St. Louis) > Recurrent PSC '02,(re)Born on the 4th of July, 2003(U of Iowa) > > " Face the worst; Expect the Best; > > Do the most, Forget the rest. " > Thanks, one of the problems we have is that the biopsy recently done at University of Virginia Hospital was so badly done that the pathologists there misread it. The Hepatologist as MCV was the one who re-read it and said there was significant fibrosis but could not stage it due to the por quality. Lawrence G. Leichtman, MD PO Box 4548 Virginia Beach, VA 23454 www.lleichtman.org Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.