Alimentary Pharmacology & Therapeutics · 4 authors, 3 centres
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This scoping review evaluated therapies targeting the gut-liver axis for primary sclerosing cholangitis. The central finding was that while vancomycin showed improvement in alkaline phosphatase in randomized trials, no microbiome-targeted therapy has been proven to improve transplant-free survival.
This scoping review searched PubMed and the Cochrane Library for studies evaluating gastrointestinal microbiome manipulation in primary sclerosing cholangitis (PSC). The authors found that antibiotics, particularly vancomycin, have been studied, with two randomized controlled trials reporting improvement in alkaline phosphatase and Mayo Risk Scores. However, other antibiotics showed variable results, and non-antibiotic strategies like faecal microbiota transplantation and dietary therapy are promising for improving microbial diversity but lack robust efficacy data from large trials. The review concludes that no therapy has been shown to improve transplant-free survival, highlighting the need for well-designed clinical trials with long-term follow-up. Limitations include the rarity of PSC and the early stage of evidence for most interventions.
