The liver produces bile to help digest food in the intestine. Bile from liver cells is transported through the bile ducts in the biliary tree, where it then enters the gallbladder. When food enters the small intestine, bile helps break down fat into fatty acids so that they can be absorbed and used by the body. Bile also helps in the absorption of fat-soluble vitamins (A, D, E & K).

As the bile ducts become inflamed and narrow, bile cannot easily flow and begins to back up. This increases the pressure within the liver causing liver cells to become inflamed. Over time, this inflammation decreases blood flow within the liver, increasing the pressure in the portal vein. This eventually causes portal hypertension, a backup in the portal system causing veins that line the esophagus, stomach, and intestine to swell (varices) and the spleen to swell (splenomegaly).

As the disease progress, liver cells die and are replaced by scar tissue. This is called cirrhosis and is associated with liver failure.

The cause of Primary sclerosing cholangitis (PSC) is unknown but it has an association with inflammatory bowel disease, especially ulcerative colitis.

Some research thought that there may be an autoimmune component to the disease, where the body’s immune system attacks the bile ducts in the liver and causes them to become, inflamed and narrowed but I (Dr. Qaisar Ahmed) am not agreeing with them, and cous of it you will find in the end in treatment section.

Primary sclerosing cholangitis (PSC) is more often seen in men in the 20-30 years age range. There is an association with inflammatory bowel, disease, most often with ulcerative colitis and less commonly with Crohn’s Disease.

People with Primary sclerosing cholangitis (PSC) who do not have inflammatory bowel disease, are more likely to be female and older.

In its early stages, Primary sclerosing cholangitis (PSC) is asymptomatic (there are no symptoms). It is only when the person develops cholestasis because of the inability of bile to drain from the liver, do symptoms occur.

These early symptoms include itching and fatigue. As the bilirubin levels in the blood become elevated, jaundice or a yellowish tinge to the skin, may occur. Since there may be liver inflammation, the patient may complain of pain beneath the ribs in the right upper quadrant of the abdomen.

The inability of the bile ducts to adequately drain reduces the flow of bile and there can be sludge formation in the bile ducts leading to the risk of infection. This may cause fever and increased pain.

Because Primary sclerosing cholangitis (PSC) is a progressive disease, symptoms may come and go over several months and years after the diagnosis is made.

As the disease progresses, cirrhosis may occur leading to decreased liver function and its associated signs and symptoms. These include bleeding from the esophagus and stomach due to varices, ascites (fluid collection in the abdomen) because of poor protein production by the liver, easy bruising because of decreased platelets in the blood as because they are trapped in the enlarged spleen, and confusion due to hepatic encephalopathy because the liver cannot clear waste products of metabolism.

Primary sclerosing cholangitis (PSC) may remain silent for several years before symptoms arise. In patients with inflammatory bowel disease, the health care professional should have a high suspicion of the diagnosis because of the relationship between PSC and ulcerative colitis.

Depending upon how far the disease has progressed and the effect on liver function, physical examination may reveal an enlarged liver, tenderness in the right upper quadrant beneath the ribs, and an enlarged spleen. The skin may be jaundiced or yellow and there can be evidence of scratching due to intense skin itching. In cirrhosis with end stage liver disease, there may be bruising of the skin, a swollen abdomen due to ascites or fluid caused by decreased protein production and decreased blood flow through the scarred liver, gastrointestinal bleeding, and mental confusion because of elevated ammonia levels in the bloodstream.

Blood tests

Blood tests are helpful in assessing the liver and potential blockages within the bile ducts. These may include a complete blood count, INR/PTT (that measures blood clotting and the ability of the liver to produce clotting factors), liver function studies including AST, and ALT to assess liver inflammation, alkaline phosphatase and bilirubin which measure the degree of bile blockage.

Imaging tests may include ultrasound to look at the liver structure and magnetic resonance cholangiogram, an MRI of the abdomen that can assess the bile duct structure of the liver.

If the diagnosis based on laboratory tests and imaging is still in doubt, a biopsy may be performed.

The allopathic treatment of Primary sclerosing cholangitis (PSC) is supportive, monitoring the progression of the disease and treating symptoms and complications as they arise. The only “cure” in allopathic medicine is liver transplantation, which may be an option when the disease progresses to cirrhosis and the liver function is affected.

When some of the larger bile ducts become blocked, there is potential to open them with ERCP (endoscopic retrograde cholangiopancreatography) and balloon dilatation and/or stent placement. A gastroenterologist passes a thin video endoscope into the mouth and threads it through the stomach into the duodenum and using a catheter, enters the bile ducts. Should a narrow duct or stricture be found, a balloon can be used to dilate the narrowing and a stent can be placed to keep the duct open. This is similar to how a cardiologist opens a blocked blood vessel in the heart

In some cases, surgery may be an option to remove some scarred and blocked bile ducts and having more normal bile ducts reconnected bypassing scarred areas of the bile ducts.

There is no allopathic medication that is approved to treat primary sclerosing cholangitis, but medications may be used to control symptoms. Ursodiol (Actigal), also known as ursodeoxycholic acid (UDCA), may improve liver function tests but has not been shown to increase survival and may be associated with complications like bleeding. While it is thought that PSC may be an autoimmune disease, immunosuppressive medications have not been shown to work.

Itching is often treated with antihistamines including diphenhydramine (Benadryl), hydroxyzine (Atarax) and cyproheptadine (Periactin). Cholestyramine (Questrom, Questrom Light), a medication that helps bind bile salts may also be helpful. Should infection occur, treatment may require antibiotics.

As the disease progresses, the damaged liver may not be able to help with the absorption of vitamins and nutrients from the intestine. Vitamins and other dietary and calorie supplements may be required to treat malnutrition.

Liver transplant is the only “cure” for primary sclerosing cholangitis, but it is only recommended for patients whose disease has progressed to liver failure. The three-year U.S. survival rate for all transplants is 81%. The five-year survival rate is about 75%, according to the data from the Scientific Registry of Transplant Recipients.

The goal of liver transplantation is to restore liver function. Though unlikely, it is possible for PSC to recur in the new liver.

Homeopathic Treatment of Primary Sclerosing Cholangitis

Cardus Marianus

The action of Cardus Marianus is centered in the liver, and portal system. Has specific relation to the vascular system. Abuse of alcoholic beverages, especially beer. Soreness, pain, jaundice. Varicose veins and ulcers. Miners’ asthma. Dropsical conditions depending on liver disease, and when due to pelvic congestion and hepatic disease. Disturbs sugar metabolism. Debility. Hemorrhages, especially connected with hepatic disease, ascites.

Liver pain and sensitiveness, feel fatigued or tired and have bouts of nausea and vomiting due to Liver Cirrhosis. Taste bitter. Appetite small; tongue furred; nausea; retching; vomiting of green, acid fluid. Stitches in left side of stomach, near spleen. Gallstone disease with hepatomegaly.

Constipation; stools hard, difficult, knotty; alternates with diarrhea. Stools bright yellow. Swelling of gallbladder with painful tenderness. Hyperemia of liver, with jaundice. Cirrhosis, with dropsy. Weeping piles, rectal prolapse, burning pain in anus and rectum, hard and knotting, clayey stools. Profuse diarrhea due to rectal cancer. Itching on lying down at night. Varicose ulcers. Eruption on lower part of sternum.

Belladonna

Belladonna acts upon every part of the nervous system. Active congestion, furious excitement, perverted special senses, twitching, convulsions and pain. It has a marked action on the vascular system, skin and glands. Belladonna always is associated with hot, red skin, flushed face, glaring eyes, dryness of mouth and throat with aversion to water, neuralgic pains that come and go suddenly, Spasmodic pain in epigastrium. Constriction: pain runs to spine. Nausea and vomiting. Great thirst for cold water. Spasms of stomach. Empty retching. Abhorrence of liquids. Spasmodic hiccough. Dread of drinking. Uncontrollable vomiting.

Abdomen distended, hot. Transverse colon protrudes like a pad. Tender, swollen. Pain as if clutched by a hand; worse, jar, pressure. Cutting pain across; stitches in left side of abdomen, when coughing, sneezing, or touching it. Extreme sensitiveness to touch.

Stools thin, green, dysenteric; in lumps like chalk. Shuddering during stool. Stinging pain in rectum; spasmodic stricture. Piles more sensitive with backache. Prolapses anis. Urine scanty, with tenesmus; dark and turbid, loaded with phosphates. Vesical region sensitive. Incontinence, continuous dropping. Frequent and profuse. Hematuria where no pathological condition can be found. Prostatic hypertrophy.

Chelidonium Majus

A prominent liver remedy, covering many of the direct reflex symptoms of diseased conditions of that organ. The jaundiced skin, and especially the constant pain under inferior angle of right scapula, are certain indications. Paralytic drawing and lameness in single parts. The great general lethargy and indisposition to make any effort is also marked. Ailments brought on or renewed by change of weather. Serous effusions. Hydrocele. Bilious complication during gestation.

Tongue yellow, with imprint of teeth; large and flabby. Taste bitter, pasty. Bad odor from mouth. Prefers hot food and drink. Nausea, vomiting. Pain through stomach to back and right shoulder-blade. Gastralgia. Eating relieves temporarily, especially when accompanied with hepatic symptoms. Jaundice due to hepatic and gall-bladder obstruction. Gall-colic. Distention. Fermentation and sluggish bowels. Constriction across, as by a string. Liver enlarged. Gallstones.

Constipation; stools hard, round balls, like sheep’s dung, bright yellow, pasty; clay-colored, stools float in water; alternation of diarrhea and constipation. Burning and itching of anus.

Skin dry heat of skin; itches, yellow. Painful red pimples and pustules. Old, spreading, offensive ulcers. Wilted skin. Sallow, cold, clammy. Pain in nape. Stiff neck, head drawn to left. Fixed pain under inner and lower angle of right scapula. Pain at lower angle of left scapula. Pain in arms, shoulders, hands, tips of fingers. Icy coldness of tips of fingers; wrists sore, tearing in metacarpal bones. Whole flesh sore to touch. Rheumatic pain in hips and thighs; intolerable pains in heels, as if pinched by too narrow a shoe; worse, right. Feels paralyzed. Paresis of the lower limbs with rigidity of muscles.

Berberis Vulgaris

Nausea before breakfast. Heartburn. Stitches in region of gallbladder; worse, pressure, extending to stomach. Catarrh of the gallbladder with constipation and yellow complexion. Stitching pain in front of kidneys extending to liver, spleen, stomach, groins, Poupart’s ligament. Sticking deep in ilium. Constant urging to stool. Diarrhea painless, clay-colored, burning, and smarting in anus and perineum. Tearing around anus. Anal fistula.

Flat warts. Itching, burning and smarting; worse, scratching; better, cold applications. Small pustules over whole body. Eczema of anus and hands. Circumscribed pigmentation following eczematous inflammation. Cold sensation in various parts. Warmth in lower part of back, hips, and thighs.

Hydrastis Canadensisa

Sore feeling in stomach more or less constant. Weak digestion. Bitter taste. Pain as from a hard-cornered substance. Gone feeling. Pulsation in epigastrium. Cannot eat bread or vegetables. Atonic dyspepsia. Ulcers and cancer. Gastritis. Gastro-duodenal catarrh. Liver torpid, tender. Jaundice. Gallstones. Dull dragging in right groin with cutting sensation into right testicle.

Mercurius Solubilis

Putrid eructation. Intense thirst for cold drinks. Weak digestion, with continuous hunger. Stomach sensitive to touch. Hiccough and regurgitation. Feels replete and constricted. Stabbing pain, with chilliness. Boring pain in right groin. Flatulent distention, with pain. Hepatomegaly; sore to touch, indurated. Jaundice. Bile secreted deficiently.

Lycopodium

Corresponds to Grau ogle’s carbo-nitrogenous constitution, the non-eliminative lithaemic. Lycopodium is adapted more especially to ailments gradually developing, functional power weakening, with failures of the digestive powers, the function of the liver is seriously disturbed. Atony. Malnutrition. Mild temperaments of lymphatic constitution, with catarrhal tendencies; older persons, the skin shows yellowish spots, earthy complexion, uric acid diathesis, etc.

Dyspepsia due to farinaceous and fermentable food, cabbage, beans, etc. Excessive hunger. Aversion to bread, etc. Food tastes sour. Sour eructation. Great weakness of digestion. Bulimia, with much bloating. After eating, pressure in stomach, with bitter taste in mouth. Eating ever so little creates fullness. Night hunger. Hiccough. Incomplete burning eructation rise only to pharynx there burn for hours. Best adapted to persons intellectually keen, but of weak, muscular power.

Deep-seated, progressive, chronic diseases. Carcinoma. Emaciation. Debility in morning. Marked regulating influence upon the glandular (sebaceous) secretions. Pre-senility. Ascites lacks vital heat (immune system); has poor circulation, cold extremities. Pains come and go suddenly. Sensitive to noise and odors. Cirrhosis of Liver when the liver has atrophied due to long-standing Cirrhosis. Hepatitis may be predominantly present.

Abdomen bloated, full. Constant sense of fermentation in abdomen. Liver sensitive. Brown spots on abdomen. Dropsy, due to hepatic disease. Hepatitis, atrophic from of nutmeg liver. Diarrhea. Inactive intestinal canal. Ineffectual urging. Stool hard, difficult, small, incomplete. Hemorrhoids; very painful to touch, aching.

Arsenic Album

A profoundly acting remedy on every organ and tissue. Its clear-cut characteristic symptoms and correspondence to many severe types of disease make its homeopathic employment constant and certain.

Liver Cirrhosis with fatigue as the main symptom. The patient feels totally exhausted from doing a little labor. Cannot bear the sight or smell of food. Great thirst; drinks much, but little at a time. Nausea, retching, vomiting, after eating or drinking. Anxiety in pit of stomach. Burning pain. Craves acids and coffee. Heartburn: gulping up of acid and bitter substances which seem to excoriate the throat. Long-lasting eructation. Vomiting of blood, bile, green mucus, or brown-black mixed with blood. Stomach extremely irritable; seems raw, as if torn. Gastralgia from slightest food or drink. Dyspepsia from vinegar, acids, ice-cream, ice-water, tobacco.

Gnawing, burning abdominal pains; relieved by heat. Liver and spleen enlarged and painful. Ascites and anasarca. Abdomen swollen and painful. Pain as from a wound in abdomen on coughing. Small, offensive, dark stool, with prostration. Dysentery dark, bloody, very offensive. Cholera, with intense agony, prostration, and burning thirst. Burning hemorrhoids. Skin excoriated about anus.

Urine scanty, burning, involuntary. Bladder as if paralyzed. Albuminous. Epithelial cells; cylindrical clots of fibrin and globules of pus and blood. Bright’s disease. Diabetes.

Nux Vomica

Liver Cirrhosis due to alcoholism, chronic acidity and constipation. Sour mouth taste, and nausea in the morning, after eating. Weight and pain in stomach. Flatulence and pyrosis. Sour, bitter eructation. Nausea and vomiting, with much retching. Ravenous hunger, especially about a day before an attack of dyspepsia. Epigastrium bloated, with pressure s of a stone, loves fats and tolerates them well. Dyspepsia from strong tea and/or coffee. Difficult belching of gas. Wants to vomit but cannot. soreness or stitching pain in liver region.

Flatulent distension, with spasmodic colic. Colic from uncovering. Liver engorged, with stitches and soreness. Colic, with upward pressure, causing short breath, and desire for stool. Constipation, with frequent ineffectual urging, incomplete and unsatisfactory. Alternate constipation and diarrhea-after abuse of allopathic purgatives. Itching, blind/non-weeping hemorrhoids, with ineffectual urging to stool; very painful; after drastic allopathic drugs. Constant uneasiness in rectum. Diarrhea, with jaundice.

Phosphorus

Phosphorus is a destructive metabolism. Yellow atrophy of the liver and sub-acute hepatitis, jaundice in patients with Cirrhosis of Liver, stool very offensive, vomiting of blood, desire for cold drinks, juices and ice creams. Hunger soon after eating. Sour taste and sour eructation after every meal. Belching large quantities of wind, after eating. Gastroesophageal reflux disease (GERD). Vomiting: water is thrown up as soon as it gets warm in the stomach. Pain in stomach; relieved by cold food, ices. Region of stomach painful to touch, or on walking. Inflammation of stomach, with burning extending to throat and bowels. Bad effects of eating too much salt.

Abdomen feels cold. Sharp, cutting pains. A very weak, empty, gone sensation felt in whole abdominal cavity. Liver congested. Acute hepatitis. Fatty degeneration. Jaundice. Pancreatic disease. Large, yellow spots on abdomen. Very fetid stools and flatus. Long, narrow, hard, like a dog’s and difficult to expel. Desire for stool on lying especially on left side. Painless, copious debilitating diarrhea. Green mucus with grains like sago. Involuntary; seems as if anus remained open. Great weakness after stool. Discharge of blood from rectum, during stool. White, hard stools. Bleeding hemorrhoids.

Apocynum Cannabinum

Increases secretions of mucous and serous membranes and acts on cellular tissue, reducing edema and dropsy.

Nausea, with drowsiness. Thirst on walking. Excessive vomiting. Food or water is immediately ejected. Dull, heavy, sick feeling. Oppression in epigastrium and chest, impeding breathing (Lobelia infl). Sensation of sinking in stomach. Abdomen bloated. Ascites.

Stool: Watery, flatulent, with soreness in anus; worse after eating. Feeling as if sphincter were open and stools ran right out.

Urinary bladder distended. Turbid, hot urine, with thick mucus and burning in urethra, after urinating. Little expulsive power. Dribbling. Strangury. Renal Dropsy.

Quassia Amara

Acts on gastric organs as a tonic. Seems to possess marked action on eyes, treating amblyopia and cataract. Pain in right intercostal muscles above the liver. Pressure and stitches in liver, and sympathetically in spleen.

Atonic dyspepsia, with gas and acidity. Heartburn and gastralgia. Regurgitation of food. Abdomen feels empty and retracted. Dyspepsia after infectious diseases; especially grip, dysentery. Tongue dry or with brown sticky coating. Cirrhosis of liver with ascites.

Excessive desire-impossible to retain urine; copious micturition day and night. As soon as the child wakes up the bed is drenched.

Inclination to yawn and stretch. Sensation of coldness over back. Prostration, with hunger. Cold extremities, with sensation of internal coldness.

Vanadium Metallicum

Hepatic infections. Hepatic inflammation. Indigestion. Anemia. Splenic cough. Tuberculosis. Fatty liver.

Thlaspi Bursa Pastoris

Cramping pain in stomach; toes hurt as well as stomach. Sick, faint feeling in stomach. Gall-stone colic; liver affection being secondary to uterine condition. Pain between end of sternum and umbilicus, like needles or an electric shock. Severe cramping pain.

Bloody stool. Obstinate and copious muco-purulent discharge from bowels, more like pus than mucus; discharge never comes till faeces have entirely passed.

Myllifolium

Painful gnawing and digging in stomach as from hunger. Burning in stomach, extending to chest. Violent pain in pit of stomach (during retrogressive smallpox). Vomiting when coughing. Nausea with vertigo. Hematemesis. Cramps in stomach, with a sensation of a liquid flowing from stomach to anus. Burning pain in stomach. Sensation of fulness in stomach as if stomach were contracted and filled with earth. Eructation.

Pain in region of liver. Congestions to portal system. Colic during menstruation. Ascites. Incarcerated hernia. Pain as from incarcerated flatulence. Frequent emission of fetid flatulence. Violent colic, with bloody diarrhea (during pregnancy). Dysentery. Abdomen distended.

Bleeding hemorrhoids; profuse flow of blood from bowels. Diarrhea, preceded by rattling of fluids in abdomen, profuse chocolate-colored stools, changing to black, very offensive, becoming blood-streaked. Mucous diarrhea; bloody; dysentery. Ascarides.

Primary sclerosing cholangitis (PSC) is a progressive disease, damaging the bile ducts and reducing the bile flow, ultimately leading to portal hypertension, cirrhosis, and liver failure.

Some cancers are associated with primary sclerosing cholangitis including gallbladder cancer, hepatocellular cancer (cancer of the liver cells) and cholangiocarcinoma (cancer of the bile ducts). The combination of inflammatory bowel disease and PSC increases the risk of developing cancers of the colon and rectum.

Aside from liver transplantation, Homeopathy is an effective treatment for Primary sclerosing cholangitis (PSC), the treatment duration is almost 3-6 months deepening on the stage and life style of the patient.

P. S: This article is only for doctors and students having good knowledge about Homeopathy and allopathy.

For proper consultation and treatment, please visit our clinic.

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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