Celiac Disease

Celiac disease, also known as celiac sprue or gluten sensitive enteropathy, is a digestive disease that causes damage to the small intestine. This sheet is not meant to give exhaustive information about celiac disease, but to give you further resources where you can gain current, helpful information.

What is celiac disease?

For people with celiac disease, eating foods containing gluten causes damage to the lining of the small intestine. Gluten is a very common protein found in wheat, rye, barley and possibly oats. The small intestine normally has many “finger-like” projections called villi where nutrients from food are absorbed into the body. When a person with celiac disease eats gluten, these villi are blunted or cut off. The body is then not able to absorb nutrients properly. This may lead to malnutrition. Celiac disease is relatively common, especially in certain populations. It has a genetic component and can be seen in different members of the same family.

What are the symptoms of celiac disease?

The symptoms of celiac disease vary. The more “classic” signs include diarrhea, difficulty gaining weight or weight loss, abdominal pain or bloating, or other signs of malnutrition. There may also be signs in areas of the body other than the stomach and intestines. Since screening tests have become available, more people have been diagnosed without “classic” symptoms.

How is it diagnosed?

Blood tests can be used to screen for celiac disease and to monitor the results of a gluten-free diet. Results of the blood tests can vary, so your doctor will help interpret the findings. Since treatment requires a life-long dietary change, the diagnosis is not made from the blood tests alone but from an intestinal biopsy using an endoscope. During this procedure, a small tube is passed through the mouth and stomach, and then into the small intestine. Biopsies, or small scrapings of tissue, are removed from the small intestine and sent to a lab where they are examined under the microscope to see if the villi are damaged.

How is celiac disease treated?

The only treatment for celiac disease is a gluten-free diet. By following a strict gluten-free diet, the villi in the lining of the intestine will return to normal and will work properly to absorb nutrients. Since gluten is present in so many foods this diet can be challenging; however, it is also extremely effective in preventing problems associated with celiac disease.

What are the complications of celiac disease?

Short term, celiac disease may significantly affect childhood growth and development. Problems seen with malnutrition, such as anemia (low iron in the blood), can affect people of all ages. Long-term complications include osteoporosis (weakening of the bones), seizures and cancers of the intestine. Miscarriage or birth defects may be more common in women with untreated celiac disease.

Websites:

Cleveland, Ohio: www.glutenfreeincleveland.blogspot.com
Restaurants by Location: www.specialgourmets.com/resource

Colon Polyps

What is a colon polyp?

A colon polyp is an abnormal growth of the tissue in the large bowel (colon). There are different types of colon polyps and not all have the potential to turn into cancer.

• Hyperplastic polyps are generally thought to be harmless. They do not become cancerous
• Adenomatous polyp, or adenoma, is a precancerous polyp and can be distinguished from other types of polyps by a pathologist when tissue samples are examined under a microscope. These polyps have the potential to turn into cancer. Removal of adenomatous polyps prevents them from becoming cancerous.

When will another colonoscopy be necessary?

This depends on the size, number, location, and type of polyp(s) removed. It may also depend if your family history includes family members with a history of colon cancer or colon polyps. A final recommendation may depend on the type of polyp, as determined by the pathologist, as well as an assessment of other risk factors by your gastroenterologist. The responsibility for scheduling and completing your next colonoscopy is yours.

If you experience a persistent change in bowel habits, bleeding, and/or abdominal pain, colonoscopy may be needed sooner than the recommended follow up, call our office at 216-593-7700 to make an appointment with one of our physicians.

Constipation

What is constipation?

Constipation is defined as infrequent bowel movements, hard to pass stools or straining during bowel movements that is troubling to the individual. Frequency of bowel movements among healthy people varies widely from three bowel movements each day to three bowel movements a week.

What causes constipation?

Many factors can lead to constipation including a diet that is low in fiber, inadequate fluid intake, and low levels of physical activity, medications, and poor bowel habits. Medical problems that can cause constipation include diabetes, hypothyroidism, neurologic and connective tissue disorders, and colorectal cancer. Alterations in bowel motility or the coordination of the muscles involved in having a bowel movement can also cause constipation.

What are the signs and symptoms of constipation?

• Passing stool fewer than 3 times per week
• Abdominal bloating or discomfort
• Straining frequently during bowel movements
• A sensation of incomplete bowel movements
• Having to apply manual pressure to have a bowel movement.

How is constipation diagnosed?

Diagnosing the cause for constipation often requires a medical history and physical exam. Your doctor will determine if an underlying disorder is causing constipation, and treatment will be directed toward the specific causes.

What are the treatment options?

For many people, lifestyle and dietary changes are all that are needed to relieve constipation.

• Dietary: Choose foods that are high in fiber including fruits and vegetables, beans and high fiber cereals and breads. Make sure you drink plenty of non-caffeinated beverages.
• Bowel Habits: Sufficient time should be set aside to allow for undisturbed visits to the bathroom. This is often most productive after breakfast. The urge to have a bowel movement should not be ignored
• Increase physical activity: Try to exercise regularly, including actives such as walking, biking, or swimming

Along with lifestyle changes your doctor may recommend other treatment options including:

• Fiber supplements: Metamucil®or Citrucel® are natural supplements that help make stools softer and are safe to use every day.
• Laxatives: Laxative is a general term for medications that can promote bowel movements. Some work by stimulating the bowel or rectum while others change the consistency of the stool. An example includes Miralax® which works by drawing water into the colon. Some patients require combinations of medications for their type of constipation.
• Medical Tests: A colonoscopy, a motility study, or even special tests to look at the muscles involved in having a bowel movement may be indicated.
• Biofeedback or Surgery: Rarely, patients with pelvic muscle abnormalities may require biofeedback or surgery.

Seeking medical advice:
You should contact your doctor if you experience an unexplained change in bowel habits or if you have any of the following signs and/or symptoms:

• Pain and straining with bowel movement that does not improve with diet and lifestyle changes
• Blood in your stool
• Rectal pain
• Constipation that alternates with diarrhea
• Thin-pencil like stools
• Unexplained weight loss
• Tissue protruding from the rectum when you bear down.

Dysphagia

What is dysphagia?

If you have a problem swallowing foods or liquids, you may have dysphagia. This means it may take more time and effort to move food or liquid from your mouth to your stomach. Difficulty swallowing may also be associated with pain. In some cases you may not be able to swallow.

What causes dysphagia?

Dysphagia occurs when there’s a problem with any part of the swallowing process.

Dysphagia can be caused by any of the following:

• A problem in the esophagus, such as an ulcer,a stricture (narrowing of the esophagus), or cancer.
• Muscles in your mouth, throat or esophagus that don’t work right.
• A nerve or brain problem (such as stroke) that leaves your mouth, tongue, or throat muscles weak or change how your muscles coordinate.
• Foreign bodies such as a large piece of meat or another object that become lodged in your throat or esophagus.

What are the symptoms of dysphagia?

Symptoms of dysphagia may include:

• A feeling of chest pressure or pain when you swallow.
• Choking or coughing when swallowing.
• Vomiting after eating or drinking.
• Aspirating (inhaling into the lungs) food or liquids when you swallow.
• Fatigue and unexpected weight loss.
• Frequent heartburn.

How is dysphagia diagnosed?

Your doctor will likely perform a physical examination and use a variety of tests to determine the cause of your swallowing problem. These tests could include a barium swallow x-ray, an upper endoscopy (EGD), or an esophageal muscle test (manometry).

How is dysphagia treated?

The treatment options for dysphagia will be based on the particular type or cause of your swallowing disorder.

• Esophagus dilation: Dilation is a procedure that your doctor can use to widen the esophagus and is most often done when a stricture is causing your dysphagia.
• Medications: Your doctor may prescribe medications to neutralize or reduce stomach acids, or to control esophagus muscle spasms.
• Diet modification: Eat slowly, don’t talk while you eat, take small bites, sit in an upright position after meals, use a blender to puree solid foods if needed, thicken liquids with milk, juice, broth, gravy or starch to make swallowing easier.

Eosinophilic Esophagitis (EE)

What is eosinophilic esophagitis (EE)?

Eosinophilic esophagitis is one of many types of esophagitis (inflammation of the esophagus). It is not as common as reflux esophagitis, but has many of the same symptoms. It is caused by an abnormal accumulation of eosinophils in the lining of the esophagus (swallowing tube). Eosinophils are a type of blood cell that can be seen in the esophagus. In this condition they are present at an increased level. The reason for this increased accumulation is unknown. Often individuals with eosinophilic esophagitis have allergies or an allergic disorder (i.e. asthma, allergic rhinitis, urticaria, etc.).

What are the symptoms of eosinophilic esophagitis?

Symptoms often include heartburn and more commonly difficulty in swallowing, or the feeling that food is getting caught or stuck in the esophagus.

How common is eosinophilic esophagitis?

Eosinophilic esophagitis is a rare condition. Of those adults affected with EE, the majority are men in their 20-30s. Children can also be affected.

How do you know if you have eosinophilic esophagitis?

The only way to diagnose eosinophilic esophagitis is by upper endoscopy with biopsies (tissue samples) of the esophagus. Upper endoscopy or EGD (esophagogastroduodenoscopy) is a procedure where a small lighted tube is passed through your mouth into your esophagus, stomach and first portion of your small intestine. The tube that is used has a camera within it and is connected to a computer. This test allows the doctor to see the lining of your esophagus, stomach and first portion of your small intestine. Pictures can be taken and can be part of your medical record. Biopsies can be taken at the time of endoscopy. There is no pain associated with taking biopsies.

Findings at the time of endoscopy can show a normal appearing esophagus or an esophagus that appears to have many rings (somewhat like a spring). Biopsies show an increase in the amount of eosinophils that are present.

How is eosinophilic esophagitis treated?

Treatment involves the use of a steroid inhaler. The treatment can be repeated as necessary. If recurrent use is needed, additional anti-allergy medications can be used. Generally, patients are referred to an allergist for additional testing or treatment.

Unlike inhaled steroids where a spacer is used to help get the medication into the lungs, you are to spray the medication without a spacer. This allows for the medication to be delivered to the back of your throat and swallowed. This brings the medication in direct contact with your esophagus.

Side effects to steroid inhalers can include the development of a fungal infection in the mouth (thrush), esophagus or respiratory tract. Other typical side effects of steroids can occur, but with a lessened incidence as compared to oral medication.

Are there any complications to eosinophilic esophagitis?

The most common complication is food becoming caught in the esophagus. This can lead to erosions (irritation) or ulcerations on the wall of the esophagus.

Gastroparesis

What is Gastroparesis?

Gastroparesis refers to a delay in emptying of stomach contents into the small intestine. This can be caused by a change in the ability of the nerves to pick up information in the stomach, or the nerves that send information to the stomach telling it to contract or empty. Another cause includes the stomach muscles not being able to contract. This loss of function can be limited to the stomach or can include the esophagus and small intestine.

What causes Gastroparesis?

Gastroparesis can occur spontaneously, or as a result of:

• Thyroid abnormalities
• Diabetes Mellitus,
• An infection,
• Gastro-intestinal surgery,
• Neurological diseases,
• Pregnancy,
• Motion sickness,
• Medications that have side-effects of delayed stomach emptying.

Other causes include: Alcohol, tobacco, marijuana, Total Parenteral Nutrition (TPN), certain muscle disorders, eating disorders (anorexia nervosa, or bulimia nervosa). Symptoms may last a few hours, a few days or be chronic.

What are the Symptoms?

Symptoms of gastroparesis include nausea, vomiting, and full feeling after eating only a few bites or a small amount of what you normally eat. Other symptoms include weight loss, bloating, heartburn and abdominal pain after eating.

How do you know if you have gastroparesis?

The evaluation for gastroparesis includes:

• Blood tests that look at thyroid function, tests that evaluate for Diabetes (blood sugar, hemoglobin A1C) kidney function, electrolytes, and blood tests that look at nutritional status including a blood count, and comprehensive metabolic profile.

Radiological Tests include:

• An Upper GI x-ray. This involves drinking barium that coats the stomach, to evaluate the lining and structure. It can also show if there is something blocking the stomach from emptying.
• Gastric Emptying Study. This is a Nuclear Medicine test that can show how the stomach empties liquid and solid material into the small intestine, and how long it takes to empty. This is then compared to the normal emptying rates to give a result. This test involves eating food that is labeled with a tiny amount of radioactivity that can be seen on the scanner.

How is gastroparesis treated?

Treatment of gastroparesis includes:

• Dietary changes. Eating smaller, more frequent meals is encouraged, as opposed to the 3 meals a day type of diet. A low fat diet is encouraged, as meals higher in dietary fat may cause delay of stomach emptying. A diet low in dietary fiber has also been shown to decrease the symptoms of gastroparesis. Liquids empty more easily from the stomach, so the use of supplements like Boost or Ensure is encouraged.
• Medications that promote gastric emptying called “Prokinetics” are used. There currently are not very many drugs available. These drugs include metoclopramide (Reglan) and erythromycin. Medications that cause delayed gastric emptying should be discontinued if possible. This should be done at the direction of your doctor.
• Feeding Tubes are also used in the treatment of gastroparesis. The tubes can be placed through the nose into the esophagus, stomach and into the small intestine. They may also be placed through the abdominal wall and into the small intestine. The latter procedure would be used for more long-term feeding and is usually placed by a radiologist. The type of feeding is based on individual calorie and nutritional needs, as well as the expected duration of the feeding used.
• Enterra therapy is a newer therapy that involves the placement of a generator beneath the skin of the abdomen. Electrodes (coated wires with sensors) are then placed with one end in the muscle of the stomach and the other into the generator. The Enterra generator is similar in size and function to a cardiac pacemaker. It works by stimulating the stomach muscles to empty the stomach, and often lessens symptoms.

Are there any complications to gastroparesis?

The main complications of gastroparesis involve alteration in nutrition which can lead to weight loss and malnutrition. Discomfort is a major problem for some people. Inability to eat normally may cause emotional and social distress.

What kind of follow up will I need?

Once an appropriate treatment plan is made for you, follow-up will be determined by your response to it. Some individuals have symptoms lasting only a few weeks or months, while others have symptoms for years. Some have success with medication and need only yearly follow-up. Others with feeding tubes can be followed by their primary physician.

Bacteria and Foodborne Illness

What are foodborne illnesses?

What causes of foodborne illnesses?

Harmful bacteria are the most common cause of foodborne illnesses. Some bacteria may be present on foods when you purchase them. Raw foods are the most common source of foodborne illnesses because they are not sterile; examples include raw meat and poultry that may have become contaminated during slaughter. Seafood may become contaminated during harvest or through processing. One in 10,000 eggs may be contaminated with Salmonella inside the egg shell. Produce such as spinach, lettuce, tomatoes, sprouts, and melons can become contaminated with Salmonella, Shigella, or Escherichia coli (E. coli) O157:H7. Contamination can occur during growing, harvesting, processing, storing, shipping, or final preparation. Sources of produce contamination are varied as these foods are grown in soil and can become contaminated during growth or through processing and distribution. Contamination may also occur during food preparation in a restaurant or a home kitchen. The most common form of contamination from handled foods is the Norwalk-like virus.

What are the symptoms of foodborne illnesses?

In most cases of foodborne illnesses, symptoms resemble intestinal flu and may last a few hours or even several days. Symptoms can range from mild to serious and include

• abdominal cramps
• nausea
• vomiting
• diarrhea, which is sometimes bloody
• fever
• dehydration

What are the risk factors of foodborne illnesses?

What are the complications of foodborne illnesses?

Some micro-organisms, such as Listeria monocytogenes and Clostridium botulinum, cause far more serious symptoms than vomiting and diarrhea. They can cause spontaneous abortion or death.
In some people, especially children, hemolytic uremic syndrome (HUS) can result from infection by a particular strain of bacteria, E. coli O157:H7 and can lead to kidney failure and death. HUS is a rare disorder that affects primarily children between the ages of 1 and 10 years and is the leading cause of acute renal failure in previously healthy children. A child may become infected after consuming contaminated food or beverages, such as meat, especially undercooked ground beef; unpasteurized juices; contaminated water; or through contact with an infected person.

The most common symptoms of HUS infection are vomiting, abdominal pain, and diarrhea, which may be bloody. In 5 to 10 percent of cases, HUS develops about 5 to 10 days after the onset of illness. This disease may last from 1 to 15 days and is fatal in 3 to 5 percent of cases. Other symptoms of HUS include fever, lethargy or sluggishness, irritability, and paleness or pallor. In about half the cases, the disease progresses until it causes acute renal failure, which means the kidneys,are unable to remove waste products from the blood and excrete them into the urine. A decrease in circulating red blood cells and blood platelets and reduced blood flow to organs may lead to multiple organ failure. Seizures, heart failure, inflammation of the pancreas, and diabetes can also result. However, most children recover completely.

See a doctor right away if you or your child has any of the following symptoms with diarrhea:

• High fever – temperature over 101.5°, measured orally
• Blood in the stools
• Diarrhea that lasts more than 3 days
• Prolonged vomiting that prevents keeping liquid down and can lead to dehydration
• Signs of severe dehydration, such as dry mouth, sticky saliva, decreased urination, dizziness, fatigue, sunken eyes, low blood pressure, or increased heart rate and breathing rate
• Signs of shock, such as weak or rapid pulse or shallow breathing
• Confusion or difficulty reasoning

How are foodborne illnesses diagnosed?

How are foodborne illnesses treated?

Most cases of foodborne illnesses are mild and can be treated by increasing fluid intake, either orally or intravenously, to replace lost fluids and electrolytes. People who experience gastrointestinal or neurologic symptoms should seek medical attention.

Hemorrhoids

What are hemorrhoids?

Hemorrhoids are swollen veins in the lower portion of the rectum or anus that may be internal (located inside the lower rectum) or external (under the skin around the anus).

What causes hemorrhoids?

• Straining to move your bowels
• Sitting too long on the toilet
• Pregnancy and childbirth

What are the signs and symptoms of hemorrhoids?

• Painless bleeding
• Itching or pain in the anal region
• Protrusion of internal hemorrhoid through the anus

Treatment options and prevention

In many cases treating hemorrhoids involves steps you can take on your own.

• More Fiber: Eat more fresh fruits, leafy vegetables, and whole-grain breads and cereals and drink 6-8 glasses of water every day. Your doctor may also recommend a fiber supplement.
• Good Hygiene: Cleanse the anal area gently after each bowel movement. Avoid excessive wiping
• Comfort measures: Consider cold packs, tub baths or warm soaks (a warm sitz bath)
• Avoid long periods of standing or sitting
• Avoid straining
• Go to the bathroom as soon as you feel the urge

In cases where internal hemorrhoids have fallen outside of the anus (prolapsed) or bleed excessively, your doctor may recommend procedural treatments such as:

• Surgery
• Band ligation
• Increased medical therapy

Seeking medical advice

See your doctor if your hemorrhoids don’t improve with self-care, cause pain or bleed frequently or bleed excessively.

Hiatal Hernia

What is a hiatal hernia?

A hernia occurs when part of the body bulges into another. Your chest and abdomen are separated by your diaphragm – a large dome-shaped muscle that is responsible for a major part of breathing. A hiatal hernia occurs when the top portion of the stomach pushes through a weakened opening in the diaphragm where the food pipe (esophagus) joins your stomach (called the hiatal opening).

What causes a hiatal hernia?

The exact cause of hiatal hernias is not known. Some people develop hiatal hernias after an injury to the chest or abdomen. But anything that puts intense pressure on your abdomen – including pregnancy, straining while going to the bathroom, severe coughing, vomiting, or lifting heavy objects – can contribute to a hernia.

What are the symptoms of a hiatal hernia?

Most small hiatal hernias don’t cause problems and you may never know you have a hiatal hernia unless your doctor discovers it while checking for another condition. But a large hiatal hernia can allow food and stomach acid to back up into your esophagus, leading to heartburn, chest pain, belching and nausea.

How is a hiatal hernia diagnosed?

Your doctor may find a hiatal hernia during an endoscopy (EGD) or barium swallow x-ray while trying to determine the cause of heartburn, chest pain or upper abdominal pain.

How is a hiatal hernia treated?

Hiatal hernias that don’t cause symptoms probably will not require treatment. However, if you experience frequent gastroesophageal reflux (GERD), your doctor may recommend the following treatments:

• Weight loss: Losing weight alone may relieve your symptoms.
• Medications: Over-the-counter antacids (Maalox, Mylanta, Tums); Acid reducing medications called H-2 blockers (Pepcid, Tagamet, Zantac, Axid); Acid blocking medications called proton pump inhibitors (Prevacid, Prilosec, Dexilant, Nexium, Protonix, Zegerid, Aciphex)
• Diet Modification: Avoid fatty, spicy foods, caffeine, chocolate, onions and citrus. Eat smaller meals. Avoid eating 3 hours before bed.
• Surgery: Few people require surgery to repair a hiatal hernia. This option is usually considered only when medications and lifestyle changes fail to reduce reflux symptoms.
• Seeking medical advice for hiatal hernia?

If your symptoms are severe, occur often or are accompanied by coughing, wheezing, asthma, a sore throat, difficulty swallowing or chest pain, contact your health care provider.

Inflammatory Bowel Disease (IBD) – Adult

What is Inflammatory Bowel Disease?

Inflammatory Bowel Disease (IBD) is a group of disorders that includes ulcerative colitis and Crohn’s disease. These conditions frequently produce symptoms of abdominal pain and diarrhea. These conditions can often be difficult to diagnose due to their similarity to other conditions.

Crohn’s Disease 

Is an ongoing disorder that causes inflammation of the gastrointestinal (GI) tract. Crohn’s disease can affect any area of the GI tract, from the mouth to the anus, but it most commonly affects the lower part of the small intestine, called the ileum.

Ulcerative Colitis 

Is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. It occurs in continuous stretches of the colon, unlike Crohn’s disease, which occurs in patches anywhere in the digestive tract.

Treatment

Depending on the level of severity, treatment may require immunosuppression to control the symptom, such as prednisone, anti-TNF drugs,azathioprine (Imuran), methotrexate, or 6-mercaptopurine. More commonly, treatment of IBD requires a form of mesalamine. Often, steroids are used to control disease flares and were once acceptable as a maintenance drug. In use for several years in Crohn’s disease patients and recently in patients with ulcerative colitis, biologicals have been used such as TNF inhibitors. Severe cases may require surgery, such as bowel resection, strictureplasty or a temporary or permanent colostomy or ileostomy. Alternative medicine treatments for bowel disease exist in various forms; however such methods concentrate on controlling underlying pathology in order to avoid prolonged steroidal exposure or surgical excisement.

Usually the treatment is started by administering drugs with high anti-inflammatory effects, such as prednisone. Once the inflammation is successfully controlled, the patient is usually switched to a lighter drug to keep the disease in remission, such as Asacol, or Lialda^®, a group of drugs called mesalamines. If unsuccessful, a combination of the aforementioned immunosuppression drugs with a mesalamine (which may also have an anti-inflammatory effect) may or may not be administered, depending on the patient.

For more advanced treatment, we have an infusion center in our main office location for the administration of infliximab (Remicade^®) and certolizumab pegol (Cimzia^®)which are biological anti-inflammatory treatments used to induce and maintain IBD remission. For outpatient therapy, patients can self-inject adalimumab (Humira^®) on a weekly schedule to maintain remission.

For More Information contact the Crohn’s and Colitis Foundation of America see: http://www.ccfa.org

Primary Sclerosing Cholangitis

What is primary sclerosing cholangitis (PSC)?

PSC is a chronic disease that damages the bile ducts of the liver. Inflammation and scarring cause the bile ducts to become blocked. The blockage causes bile to accumulate in the liver which may lead to scarring or damage of the liver cells. Over time, damage of the liver cells can lead to cirrhosis. PSC usually advances slowly. People with PSC may experience episodes of infection in the liver and increased risk of cancer in the bile ducts.

What causes primary sclerosing cholangitis?

The cause of this disease is not known. It is possible the disease is related to a problem with the immune system and there may be a genetic role. PSC is more commonly found in men than women. Intestinal diseases called ulcerative colitis and Crohn’s disease are often associated with PSC.

What are the symptoms of primary sclerosing cholangitis?

Many people do not have symptoms at the time of diagnosis. However, if symptoms occur, they may include jaundice (yellowing of the skin and eyes), fatigue, and pruritus (itching of the skin). Symptoms may come and go, or gradually worsen over time.

How is primary sclerosing cholangitis diagnosed?

Often findings of abnormal liver tests lead to further testing and the diagnosis of PSC. Diagnosis is usually made by X-ray tests, MRCP (magnetic resonance cholangiopancreatography), or a specific endoscopic procedure to evaluate the bile duct called EUS/ERCP (endoscopic ultrasound, endoscopic retrograde cholangiopancreatography).

How is primary sclerosing cholangitis treated?

There is no cure for PSC. Research is not clear if a medication (ursodiol) may help slow the progression of the disease. Treatment is aimed at relieving symptoms. Itching is able to be treated with medications. PSC generally involves increased liver damage and liver transplant may be needed. ERCP may also be used to place stents to open up the bile ducts.

Additional Resources for primary sclerosing cholangitis:

PSC Partners
http://www.pscpartners.org/