Long-term treatment of primary sclerosing cholangitis in children with oral vancomycin: an immunomodulating antibiotic.
BACKGROUND
Primary sclerosing cholangitis is a rare chronic cholestatic condition of unknown etiology, frequently associated with inflammatory bowel disease and characterized by diffuse fibrosing and inflammatory destruction of the intra- and/or extrahepatic biliary duct system.


METHODS
The study involved 14 children with primary sclerosing cholangitis confirmed by either liver biopsy, endoscopic retrograde cholangiopancreatography, and/or magnetic resonance cholangiogram. In each of the 14 cases, liver histology showed characteristic features consistent with primary sclerosing cholangitis. Eleven children had intrahepatic biliary beading and strictures (6 by endoscopic retrograde cholangiopancreatography; 5 by magnetic resonance cholangiogram). Biochemical tests of liver function including alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase and the erythrocyte sedimentation rate were elevated for a mean 17 +/- 22 months before vancomycin treatment was initiated. All of the patients were shown to have inflammatory bowel disease histologically; 13 of those patients had clinical evidence of colitis. Oral vancomycin was given to all 14 patients.


RESULTS
All 14 patients showed improvement in their alanine aminotransferase (P = 0.007), gamma-glutamyl transpeptidase (P = 0.005), erythrocyte sedimentation rate (P = 0.008), and clinical symptoms with oral vancomycin treatment. There was less improvement noted in the patients with cirrhosis when compared with the patients without cirrhosis.


CONCLUSIONS
Before this study, there has not been an effective long-term treatment for sclerosing cholangitis to prevent the usual progression of this disease to cirrhosis. This study showed that oral vancomycin could be an effective long-term treatment of sclerosing cholangitis in children, especially those without cirrhosis.
Davies
Yinka K
YK
Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA 94304, USA.
Cox
Kathleen M
KM
Abdullah
Bisher A
BA
Safta
Anca
A
Terry
Annie B
AB
Cox
Kenneth L
KL
D000284:Administration, Oral; D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001799:Blood Sedimentation; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D015209:Cholangitis, Sclerosing / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008099:Liver / Q000201:enzymology* / Q000502:physiology; D008103:Liver Cirrhosis / Q000517:prevention & control; D008111:Liver Function Tests; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*; D005723:gamma-Glutamyltransferase / Q000097:blood
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D014640:Vancomycin; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase