From the Research
The treatment for biopsy-confirmed asymptomatic ascending cholangitis with elevated alkaline phosphatase and liver function tests should prioritize ursodeoxycholic acid (UDCA) therapy, as it has been shown to improve serum biochemistries, histology, and delay the need for liver transplantation 1, 2, 3. Given the patient's asymptomatic status but significantly elevated liver enzymes, the focus should be on managing the potential underlying cause of the cholangitis, which could be related to primary biliary cholangitis (PBC) or another form of cholangitis. Key considerations in the treatment approach include:
- Starting UDCA at a dose of 13-15 mg/kg per day, as recommended for patients with PBC and elevated liver enzymes 1
- Monitoring liver enzymes closely to assess treatment response, with adjustments to therapy as needed
- Considering adjunctive therapy, such as obeticholic acid, for patients who do not respond adequately to UDCA 2, 3
- Ruling out other potential causes of abnormal liver function tests, such as drug-induced liver injury or occult malignancy, through further testing and consultation with hepatology if necessary 4 The rationale for this approach is based on the most recent and highest-quality evidence, which emphasizes the importance of UDCA therapy in managing PBC and other forms of cholangitis, while also considering the need for adjunctive therapy and further evaluation to rule out other potential causes of liver dysfunction.