Dear Dr. Roach: I read your recent column on primary sclerosing cholangitis. What is the difference between this condition and primary biliary cholangitis? Where can I find information on how to get on a waiting list for a liver transplant?
— C.V.
Dear C.V.: Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are similar in some ways. They are both chronic and progressive liver diseases, whose initial symptoms can be vague (such as fatigue or skin itching) and can be found incidentally on laboratory testing. They are both largely thought to be autoimmune diseases that are probably triggered by something in the environment, and both cause the progressive destruction of the bile ducts.
As many as 80% of people with PSC have inflammatory bowel disease (IBD), especially ulcerative colitis. Some people with PBC also have IBD, but symptoms of Sjogren’s syndrome (dry eyes and mouth) are more common. PBC is most common in women between 40-70, while PSC is more common in younger men. There is a lab test for PBC (anti-mitochondrial antibodies are found in more than 95% of cases), but PSC doesn’t have a specific lab test.
PBC is more amenable to treatment, with ursodeoxycholic acid (Actigall) slowing disease progression and improving survival. Actigall is sometimes tried in people with PSC, although there isn’t a proven survival benefit with PSC the way there is with PBC.
Liver transplant is the definitive therapy for both conditions. A person with PBC is considered for a liver transplant when they have cirrhosis and complications.
(Physicians use a scale called the MELD score to quantify cirrhosis, and a score above 15 is the usual indication to list a person for a transplant. But there are other considerations.) Your liver specialist should be discussing with you whether a transplant is in your future.
CANCER (most commonly in the bile ducts and liver but also in the colon, gallbladder and pancreas) is a significant problem with PSC, and the likelihood of developing cancer is nearly 1% per year. The risk of cancer with PBC is increased compared to the general population, but it’s much smaller than in people with PSC. However, once a person has cirrhosis of any kind, liver cancer does become much more likely than it is with the general population.
Dear Dr. Roach: Our 38-year-old son has suffered from post-viral irritable bowel syndrome with diarrhea (IBS-D) for over six years. He saw several gastrointestinal physicians and tried every nutritional approach, including eating gluten-free, trying a low-FODMAP diet, and going vegan. Nothing helped.
A friend recommended THC sleep gummies that are taken at night. It seems to be working, and he’s been symptom-free for weeks. It’s like a miracle. What’s going on?
— C.R.
Dear C.R.: Several different cannabinoids (a general term for the compounds that are found in cannabis) have been studied in people with IBS. I found two studies that looked at THC, but neither of them showed a benefit.
The information you sent me about the gummies he’s taking showed that they contain both THC and CBN (cannabinol). CBN isn’t made by cannabis; it’s a breakdown product of THC. CBD (cannabidiol) doesn’t have any psychoactive effects, while CBN has much less of an effect than THC, so these gummies may have a better impact on people with fewer side effects. A synthetic cannabinoid called olorinab did show decreased abdominal pain in people with IBS.
Many people use cannabis or its containing compounds as medicine, but there isn’t enough research to identify what it provides benefit to and what it doesn’t. It’s hard to argue with the success that he’s having, though. I do wonder if the gummies are improving his sleep, and it’s the better sleep that’s helping his IBS. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
This article originally appeared on The Detroit News: Dr. Roach: Know the difference between certain types of cholangitis
Reporting by Dr. Keith Roach, To Your Health / The Detroit News
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