Article Text


Interference with the lower gut–liver axis induces remission of primary sclerosing cholangitis in a patient with ulcerative colitis
  1. John Ong1,2,
  2. Leila Mebarek2,
  3. Michael Bath3,
  4. Carla Swift4,
  5. Babur Javaid2,
  6. Jenish Patel5,
  7. Yasseen Al-Naeeb2
  1. 1 Department of Engineering, University of Cambridge, Cambridge, UK
  2. 2 Department of Gastroenterology, Bedford Hospital South Wing, Bedford, UK
  3. 3 Department of Surgery, Addenbrooke's Cambridge University Hospital, Cambridge, UK
  4. 4 Department of Gastroenterology, Addenbrooke's Cambridge University Hospital, Cambridge, UK
  5. 5 Department of Histopathology, Bedford Hospital South Wing, Bedford, UK
  1. Correspondence to Dr John Ong;{at}


The gut–liver axis describes the complex interactions between gut microbiota, the small and large bowel, the immune system and the liver. Current evidence associates abnormalities within the gut–liver axis with liver disease such as primary sclerosing cholangitis (PSC). PSC is believed to be an immune-mediated disease though the exact mechanism of its pathogenesis remains unknown. Here, we report a case of a 66 -year-old woman with treatment-resistant ulcerative colitis and PSC which continued to be active following subtotal colectomy. Interestingly, her PSC achieved full remission after proctectomy for treatment-resistant proctitis in the rectal stump. This case report supports existing hypotheses that PSC is an immune-mediated disease triggered by antigens within the gut. More notably, it suggests the yet unidentified pathogens may be localised to the lower gastrointestinal tract including the rectum.

  • primary sclerosing cholangitis
  • IBD
  • ulcerative colitis

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  • Contributors JO: wrote the manuscript and performed literature searches. LM, MB: prepared the figures, contributed to parts of the manuscript and performed literature searches. JP: analysed the histological images and contributed to the histology report. YAN, BJ: cared for the patient, obtained consent for images to be used herein and provided the case history. CS: performed literature searches, chased and retrieved investigation results. CS, YAN: edited the manuscript prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views are expressed by the authors and not necessarily their organisations or the NHS.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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