Influence of dominant bile duct stenoses and biliary infections on outcome in primary sclerosing cholangitis.
OBJECTIVE
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 the 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).


CONCLUSIONS
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.
Rudolph
Gerda
G
Department of Medicine, University of Heidelberg, Medizinische Universitätsklinik, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Gotthardt
Daniel
D
Klöters-Plachky
Petra
P
Kulaksiz
Hasan
H
Rost
Daniel
D
Stiehl
Adolf
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification*; D001646:Bile / Q000382:microbiology*; D002175:Candida / Q000302:isolation & purification*; D002648:Child; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D002779:Cholestasis / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014580:Ursodeoxycholic Acid