Being candid about Candida ...

March 27, 2009

J. Hapatol. [in Press] (2009)

Influence of dominant bile duct stenoses and biliary infections on outcome in

primary sclerosing cholangitis.

Gerda Rudolph, Gotthardt, Petra Klöters-Plachky, Hasan Kulaksiz,

Rost, Adolf Stiehl

Department of Medicine, University of Heidelberg, Medizinische

Universitätsklinik, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany

Background/Aims: In primary sclerosing cholangitis (PSC) dominant stenoses are

frequently associated with bacterial, and in part, also fungal infections of the

bile ducts. In the present study, the influence of dominant stenoses and of

biliary infections on the long-term outcome was studied.

Methods: In a prospective study, 171 patients were followed up for 20 years. All

patients were treated with ursodeoxycholic acid. Dominant stenoses were treated

endoscopically and during endoscopic procedures, bile was obtained for

microbiologic analysis.

Results: Of 171 patients 97 had or developed major bile duct stenoses and 96/97

were treated endoscopically. In the 55/97 patients with dominant stenosis, bile

samples were obtained and of these, 41/55 had bacteria, five had also Candida

and 2/55 had only Candida in their bile. Survival free of liver transplantation

in patients without dominant stenosis at 18 years was 73.1% and of patients with

dominant stenosis was 25.0% (p=0.011). Bacteria in bile had no effect on

survival whereas Candida in bile was associated with reduced survival (p=0.025).

Conclusion: In patients with dominant stenosis, survival free of liver

transplantation is reduced. Bacteria in bile do not worsen the outcome if

dominant stenoses are opened endoscopically and infection is adequately treated

with antibiotics. Candida in bile is associated with a poor prognosis and these

patients need liver transplantation relatively soon.

Abbreviations: ERCP, endoscopic retrograde cholangio-pancreaticography, PSC,

primary sclerosing cholangitis

Keywords: Sclerosing cholangitis, Biliary disease, Cholestasis, Biliary

infection, Liver disease, Endoscopic intervention, Ursodeoxycholic acid

_________________________

Dave

(father of (23); PSC 07/03; UC 08/03)

March 28, 2009

Hi ,

I, too, found the article you posted very interesting, not least because the

last one of the authors (A. Stiehl) is a hepatologist highly appreciated by our

son's hepatologist. I went ahead already to ask our son's drs (he has two drs in

Helsinki: the hepatologist and pediatric gastro) if Eemeli was tested for both

bacteria and Candida at the brushings he had at his recent ERC but of course it

takes a while to get the answer from either dr. Eemeli was prescribed

metronidazole after the brushing results came so I guess he might have had

bacteria findings, maybe??? What we were told is that he has a highly active

inflammation process going on in his bile ducts but not any further details. I

also am interested in the same question as Lori asked: if you know if there is

any way to treat the patient with Candida in the bile if there should be some?

Sounds like there is not too much that can be done about it, of if there is, A.

Stiehl would have mentioned it (that is, if there are other options than

transplanting earlier)??? Do you or someone else know what is normally tested in

the ERC brushings? Or if there is any " standard " used or if the testing varies

from centre to centre?

If you have the time to aswer Lori's and my questions (big thanks in advance) -

just put any info in the same response.

Taru-Mari, mom of Eemeli (12), PSC 7/2003 & UC 5/2008

March 28, 2009

In that book I mentioned, he gives a prescription to treat it naturally. Not that it is a cure--all but think it would be worth the try.

Lori A.

"Aggressively Pursuing Solutions To Your Real Estate Needs!"

First Weber Group

Cell:

1507 E. Sunset Drive

Waukesha, WI 53189

LoriUSA@...

www.Lori.FirstWeber.com

Click here

To: Sent: Saturday, March 28, 2009 10:16:57 AMSubject: Re: Being candid about Candida ...

Hi ,I, too, found the article you posted very interesting, not least because the last one of the authors (A. Stiehl) is a hepatologist highly appreciated by our son's hepatologist. I went ahead already to ask our son's drs (he has two drs in Helsinki: the hepatologist and pediatric gastro) if Eemeli was tested for both bacteria and Candida at the brushings he had at his recent ERC but of course it takes a while to get the answer from either dr. Eemeli was prescribed metronidazole after the brushing results came so I guess he might have had bacteria findings, maybe??? What we were told is that he has a highly active inflammation process going on in his bile ducts but not any further details. I also am interested in the same question as Lori asked: if you know if there is any way to treat the patient with Candida in the bile if there should be some? Sounds like there is not too much that can be done about it, of if there is, A. Stiehl would

have mentioned it (that is, if there are other options than transplanting earlier)??? Do you or someone else know what is normally tested in the ERC brushings? Or if there is any "standard" used or if the testing varies from centre to centre?If you have the time to aswer Lori's and my questions (big thanks in advance) - just put any info in the same response.Taru-Mari, mom of Eemeli (12), PSC 7/2003 & UC 5/2008

March 28, 2009

In that book I mentioned, he gives a prescription to treat it naturally. Not that it is a cure--all but think it would be worth the try.

Lori A.

"Aggressively Pursuing Solutions To Your Real Estate Needs!"

First Weber Group

Cell:

1507 E. Sunset Drive

Waukesha, WI 53189

LoriUSA@...

www.Lori.FirstWeber.com

Click here

To: Sent: Saturday, March 28, 2009 10:16:57 AMSubject: Re: Being candid about Candida ...

Hi ,I, too, found the article you posted very interesting, not least because the last one of the authors (A. Stiehl) is a hepatologist highly appreciated by our son's hepatologist. I went ahead already to ask our son's drs (he has two drs in Helsinki: the hepatologist and pediatric gastro) if Eemeli was tested for both bacteria and Candida at the brushings he had at his recent ERC but of course it takes a while to get the answer from either dr. Eemeli was prescribed metronidazole after the brushing results came so I guess he might have had bacteria findings, maybe??? What we were told is that he has a highly active inflammation process going on in his bile ducts but not any further details. I also am interested in the same question as Lori asked: if you know if there is any way to treat the patient with Candida in the bile if there should be some? Sounds like there is not too much that can be done about it, of if there is, A. Stiehl would

have mentioned it (that is, if there are other options than transplanting earlier)??? Do you or someone else know what is normally tested in the ERC brushings? Or if there is any "standard" used or if the testing varies from centre to centre?If you have the time to aswer Lori's and my questions (big thanks in advance) - just put any info in the same response.Taru-Mari, mom of Eemeli (12), PSC 7/2003 & UC 5/2008

March 28, 2009

In that book I mentioned, he gives a prescription to treat it naturally. Not that it is a cure--all but think it would be worth the try.

Lori A.

"Aggressively Pursuing Solutions To Your Real Estate Needs!"

First Weber Group

Cell:

1507 E. Sunset Drive

Waukesha, WI 53189

LoriUSA@...

www.Lori.FirstWeber.com

Click here

To: Sent: Saturday, March 28, 2009 10:16:57 AMSubject: Re: Being candid about Candida ...

Hi ,I, too, found the article you posted very interesting, not least because the last one of the authors (A. Stiehl) is a hepatologist highly appreciated by our son's hepatologist. I went ahead already to ask our son's drs (he has two drs in Helsinki: the hepatologist and pediatric gastro) if Eemeli was tested for both bacteria and Candida at the brushings he had at his recent ERC but of course it takes a while to get the answer from either dr. Eemeli was prescribed metronidazole after the brushing results came so I guess he might have had bacteria findings, maybe??? What we were told is that he has a highly active inflammation process going on in his bile ducts but not any further details. I also am interested in the same question as Lori asked: if you know if there is any way to treat the patient with Candida in the bile if there should be some? Sounds like there is not too much that can be done about it, of if there is, A. Stiehl would

have mentioned it (that is, if there are other options than transplanting earlier)??? Do you or someone else know what is normally tested in the ERC brushings? Or if there is any "standard" used or if the testing varies from centre to centre?If you have the time to aswer Lori's and my questions (big thanks in advance) - just put any info in the same response.Taru-Mari, mom of Eemeli (12), PSC 7/2003 & UC 5/2008

March 28, 2009

Thanks, Lori, I will try to get hold of that book, whether Eemeli has Candida or

not.

Taru-Mari, mom of Eemeli (12), PSC 7/2003 & UC 5/2008

>

> In that book I mentioned, he gives a prescription to treat it naturally. Not

that it is a cure--all but think it would be worth the try.

>

> Lori A.

>

> " Aggressively Pursuing Solutions To Your Real Estate Needs! "

>

> First Weber Group

> Cell:

> 1507 E. Sunset Drive

> Waukesha, WI 53189

> LoriUSA@...

> www.Lori.FirstWeber.com

>

> Click here

>

> ________________________________

> From: tarumt

> To:

> Sent: Saturday, March 28, 2009 10:16:57 AM

> Subject: Re: Being candid about Candida ...

>

> Hi ,

>

> I, too, found the article you posted very interesting, not least because the