Re: Ulcerative colitis, UDCA, and small-duct PSC

[Guest guest]

Thanks Dave,I like the conclusion and I am still hoping that UDCA at 25-30mg makes a difference.But is this only looking good in small duct?LeeImpact of inflammatory bowel disease and ursodeoxycholic acid therapy on small-duct primary sclerosing cholangitis.Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN.A longitudinal, cohort study was performed to characterize the clinical features of patients with small-duct primary sclerosing cholangitis (PSC) occurring with and without inflammatory bowel disease (IBD) and to determine the influence of IBD and the effect of ursodeoxycholic acid (UDCA) therapy on the course of the liver disease. Conclusion: Small-duct PSC often is recognized at an early stage in patients with IBD; however, IBD has no impact on long-term prognosis. Although UDCA therapy improves liver biochemistries, it may not delay disease progression during the short period of treatment. PMID: 17992695.But why the study used low-dose ursodeoxycholic acid (UDCA)(13-15 mg/kg/day) is not obvious to me! Why didn't they use high-dose UDCA as they proposed 6 years ago?:Harnois DM, Angulo P, nsen RA, Larusso NF, Lindor KD 2001 High-dose ursodeoxycholic acid as a therapy for patients with primary sclerosing cholangitis. Am. J. Gastroenterol. 96: 1558-1562. "This expected survival at 4 yr was significantly different between placebo and the dose of 25-30 mg/kg per day (p = 0.04), but not between placebo and the dose of 13-15 mg/kg per day (p = 0.4). High-dose UDCA was well tolerated. CONCLUSIONS: UDCA at a dose of 25-30 mg/kg per day may be of benefit for patients with PSC, and this regimen deserves further evaluation in a long-term, randomized, placebo-controlled trial."Dave R.