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Sjogren’s syndrome Autoimmune thyroid disease, eg Hashimoto’s Rheumatoid arthritis Coeliac disease Systemic sclerosis Pernicious anaemia Vitiligo Addison’s disease Pharmacotherapy Dose Notes Cholestyramine 4 g/day to a maximum of 16 g/day as required Administration requires adequate spacing to avoid affecting the absorption of other medications Rifampicin 300–600 mg/day Needs careful monitoring of LFTs; small risk of hepatotoxicity Naltrexone 50 mg/day Careful dosing required to avoid opioid withdrawal side effects Sertraline 100 mg/day Gabapentin 300 mg/day, dose titrate as normal LFTs = liver function tests.
- Box 2.
Ways in which a patient with primary sclerosing cholangitis may present to the general physician
Incidental findings of abnormal liver biochemistry in an asymptomatic individual Persistent abnormal liver biochemistry in patients followed up for inflammatory bowel disease Jaundice or pruritis secondary to cholestasis Bacterial cholangitis Jaundice secondary to liver decompensation Complications of portal hypertension (variceal bleeding or ascites) Cholangiocarcinoma or gallbladder carcinoma Chronic choledocholithiasis (bile duct stones) Chronic pancreatitis Immunoglobulin G4-related disease Traumatic bile duct injury (iatrogenic, penetrating/blunt trauma) Ischaemic bile duct injury HIV cholangiopathy Parasitic infections of the biliary tract Helminth (ascaris) Trematoda (flukes)
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