Oral vancomycin for primary sclerosing cholangitis and associated inflammatory bowel disease - paving a path forward - PubMed
a day ago
- #inflammatory bowel disease
- #oral vancomycin
- #primary sclerosing cholangitis
- Primary sclerosing cholangitis (PSC) is strongly associated with inflammatory bowel disease (PSC-IBD).
- Oral vancomycin (OV) shows consistent benefits for IBD but variable liver responses in PSC.
- In pediatric PSC-IBD, clinical and endoscopic remission rates were 60% at 6 months and 71% at 12 months.
- In an adult study, 80% achieved endoscopic remission at 4 weeks with mucosal healing and reduced fecal calprotectin.
- Liver disease improvements included ≥50% declines in gamma-glutamyl transferase in 82% of pediatric patients.
- Alkaline phosphatase fell by 46% at 12 weeks in an adult pilot randomized controlled trial.
- Imaging/histology improvements were noted in both large-duct and small-duct PSC cases.
- No vancomycin-resistant enterococci development has been reported in PSC/PSC-IBD studies.
- OV appears effective for colitis control in PSC-IBD, but liver responses may require higher doses.
- Cross-specialty guidance and integrated trials are needed due to PSC's rarity and OV's off-patent status.