Normalization of Serum Alkaline Phosphatase in Primary Sclerosing Cholangitis Associated with Ulcerative Colitis


Primary sclerosing cholangitis (PSC) is commonly associated with ulcerative colitis (UC). PSC progresses independently of UC ultimately resulting in liver failure. There is no established medical treatment to improve the natural course of PSC. Normalization of serum alkaline phosphatase (ALP) in early stage might delay the progress of PSC. A 20-year-old female, had a sudden attack of right hypochondralgia with high fever and abnormal liver function tests without elevation of bilirubin: ALP 478 IU/L, aspartate aminotransferase 360 IU/L, alanine aminotransferase 174 IU/L. Abnormal liver function tests returned to normal after the attacks. Morphological examinations initially indicated then confirmed a diagnosis of PSC. One month after displaying PSC symptoms administration of ursodeoxycholic acid was initiated. Similar attacks of cholangitis were repeated several times over the following two years. Even in the absence of these attacks, she always suffered postprandial hypochondralgia. There was no acute cholangitis in the year prior to the last hospitalization due to abdominal pain and bloody diarrhea. Findings were consistent with UC in the form of entire colitis. Sulfasalazine, metronidazole and semi-vegetarian diet (SVD) were initiated. Metronidazole is routinely used in inflammatory bowel disease (IBD) in our practice with the expectation of elimination of any potentially pathogenic bacteria. SVD was designed for IBD hoping to increase beneficial bacteria. A remission of UC was ascertained during hospitalization. Elevated ALP, in the absence of clinical cholangitis, was decreased to normal after the therapy for UC.

Share and Cite:

Chiba, M. , Tsuda, H. , Tsuda, S. , Komatsu, M. , Horie, Y. and Ohnishi, H. (2014) Normalization of Serum Alkaline Phosphatase in Primary Sclerosing Cholangitis Associated with Ulcerative Colitis. Health, 6, 969-974. doi: 10.4236/health.2014.610122.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Stanich, P.P., Bjornsson, E., Gossard, A.A., Enders, F., Jorgensen, R. and Lindor, K.D. (2011) Alkaline Phosphatase Normalization Is Associated with Better Prognosis in Primary Sclerosing Cholangitis. Digestve and Liver Disease, 43, 309-313.
[2] Aron, J.H. and Bowlus, C.L. (2009) The Immunobiology of Primary Sclerosing Cholangitis. Seminars in Immunopathology, 31, 383-397.
[3] Triantos, C.K., Koukias, N.M., Nikolopoulou, V.N. and Burroughs, A.K. (2011) Meta-Analysis: Ursodeoxycholic Acid for Primary Sclerosing Cholangitis. Alimentary Pharmacology & Therapeutics, 34, 901-910.
[4] Imam, M.H., Sinakos, E., Gossard, A.A., et al. (2011) High-Dose Ursodeoxycholic Acid Increases Risk of Adverse Outcomes in Patients with Early Stage Primary Sclerosing Cholangitis. Alimentary Pharmacology & Therapeutics, 34, 1185-1192.
[5] Tabibian, J.H., Weeding, E., Jorgensen, R.A., et al. (2013) Randomised Clinical Trial: Vancomycin or Metronidazole in Patients with Primary Sclerosing Cholangitis—A Pilot Study. Alimentary Pharmacology & Therapeutics, 37, 604-612.
[6] Sartor, R.B. (2004) Therapeutic Manipulation of the Enteric Microflora in Inflammatory Bowel Diseases: Antibiotics, Probiotics, and Prebiotics. Gastroenterology, 126, 1620-1633.
[7] Chiba, M., Tsuda, H., Abe, T., Sugawara, T. and Morikawa, Y. (2011) Missing Environmental Factor in Inflammatory Bowel Disease: Diet-Associated Gut Microflora. Inflammatory Bowel Diseases, 17, E82-E83.
[8] Chiba, M., Abe, T., Tsuda, H., et al. (2010) Lifestyle-Related Disease in Crohn’s Disease: Relapse Prevention by a Semi-Vegetarian Diet. World Journal of Gastroenterology, 16, 2484-2495.
[9] van Milligen de Wit, A.W., van Bracht, J., Rauws, E.A., Jones, E.A., Tytgat, G.N. and Huibregtse, K. (1996) Endoscopic Stent Therapy for Dominant Extrahepatic Bile Duct Strictures in Primary Sclerosing Cholangitis. Gastrointestinal Endoscopy, 44, 293-299.
[10] Tada, S., Ebinuma, H., Saito, H. and Hibi, T. (2006) Therapeutic Benefit of Sulfasalazine for Patients with Primary Sclerosing Cholangitis. Journal of Gastroenterology, 41, 388-392.
[11] Duca, I., Ramirez de la Piscina, P., Estrada, S., et al. (2013) Steroid-Refractory Ulcerative Colitis and Associated Primary Sclerosing Cholangitis Treated with Infliximab. World Journal of Gastroenterology, 19, 590-593.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.