In primary sclerosing cholangitis (PSC), the association with inflammatory bowel disease is well established. Which statement regarding PSC management is most accurate?
- A Liver transplantation is the only effective treatment for end-stage PSC, with a 5-year survival of >80% ✓
- B Ursodeoxycholic acid at high dose (28–30 mg/kg/day) improves transplant-free survival
- C ERCP with balloon dilation is the treatment of choice for all strictures
- D Regular colonoscopy surveillance is not required in PSC-associated IBD
Correct answer: A. Liver transplantation is the only effective treatment for end-stage PSC, with a 5-year survival of >80%
Explanation
Liver transplantation is the only curative treatment for PSC, with excellent post-transplant 5-year survival exceeding 80–90%. Ursodeoxycholic acid was initially promising but the Mayo Clinic trial at high doses (28–30 mg/kg/day) was actually associated with harm (higher rates of death, transplantation, or serious complications), and it is not recommended. Annual colonoscopy is mandatory in PSC-associated IBD due to markedly elevated colorectal cancer risk.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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