Is there Still a Role for Ursodeoxycholic Acid Treatment in Patients with Inflammatory Bowel Disease Associated with Primary Sclerosing Cholangitis?

Eighty percent of patients with primary sclerosing cholangitis (PSC) have IBD. In this setting, IBD has been shown to have some unique characteristics, including an increased risk of colorectal cancer (CRC). Currently, there are no reports of a medical therapy that can be able to halt PSC progression. Ursodeoxycholic acid (UDCA) has been shown to exert some beneficial effects as measured by liver biochemistry. In addition, UDCA has been suggested to act as a chemopreventive agent against CRC in patients with PSC and IBD. However, a recent randomized, controlled, high-dose UDCA trial failed to demonstrate improvement in survival and was associated with increased rates of serious adverse events; the presence of IBD did not have any effect on outcomes. Taking all the available data into consideration, we suggest that UDCA cannot be generally be recommended in patients with PSC and IBD.