Recent paper on PSC by Dr. Stiehl

[Guest guest]

Dear All;

I thought this paper might be of general interest to the group:

Eur J Gastroenterol Hepatol. 2006 Jan;18(1):69-74.

The role of dominant stenoses in bacterial infections of bile ducts

in primary sclerosing cholangitis.

Pohl J, Ring A, Stremmel W, Stiehl A

Department of Internal Medicine IV, Ruprechts Karls University,

Heidelberg, Germany.

OBJECTIVE: Primary sclerosing cholangitis (PSC) is characterized by

progressive fibrotic inflammation and strictures of the biliary

system. We studied the role of dominant stenoses in bacterial biliary

infections and the effect of routine antibiotic administration with

cholangiography. DESIGN: A prospective clinical trial without

blinding or randomization. SETTING: The endoscopy unit in a

university hospital. PARTICIPANTS: Fifty patients with PSC entered

and finished the study. INTERVENTIONS: A total of 103 endoscopic

retrograde cholangiographies (ERC) was performed in 37 PSC patients

with dominant stenosis and 13 controls with PSC but no dominant

stenosis. After selective cannulation of the bile duct, bile samples

were obtained during each procedure. All patients received systemic

antibiotic treatment with ciprofloxacin for one week after ERC.

RESULTS: Enteric bacteria were detected in the bile specimens of 15

out of 37 PSC patients (40.5%) with dominant stenosis but never in

the absence of dominant stenosis (P=0.004). Positive cultures for

enteric bacteria were associated with elevated serum C-reactive

protein, high leukocyte counts in bile (P<0.05) and the deterioration

of liver function assessed by increasing bilirubin levels during the

follow-up period lasting a median of 7 months (P=0.06). Despite the

high rate of susceptibility in vitro, ciprofloxacin treatment

eradicated enteric bacteria in only two out of 12 cases. CONCLUSION:

Bacterial infection of the bile ducts with dominant stenosis is a

frequent finding and may play a role in the progression of PSC. Short-

course antibiotic treatment is not very effective in eradicating

bacteria from the bile ducts.

PMID: 16357622

Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)