yearly colonoscopy. After liver transplant, which some of you here have had ~ because of the risks associated with immunosuppressants afterwards, it's particularly important that you have a colonoscopy every year.

Q.  About the medication for Colitis, how do they reduce colon cancer risk?

A.  I was suggesting that the medications you take for Colitis and also the Urso, you're taking for PSC may together have a beneficial protective effect on the risk of colon cancer. Surely the 5-Aminosalicylate compounds will reduce inflammation of the colon. This in itself reduces cancer risk. What we don't know is if you add Urso to this is there an added effect? It's very hard to get that sort of data. But yes, it does reduce inflammation and therefore protects against colon cancer. We don't know about CD (Crohn's Disease). I'VE NEVER SEEN ANY DYSPLASIA EVEN THOUGH PATIENTS HAVE COLITIS (Crohn's colitis).  I get asked a lot about how often you should have colonoscopy in people who have CD.  At the moment I would suggest doing it every five years if there are no problems. There is no data on which to base this. We don't know ........

Q.  I have a stent but I recently started itching again. Could the stent be blocked?

A.  What you would normally do is a MRCP and then consider changing the stent because stents do block.

A.  Which was exactly the case in our previous study.  So we’ve shown twice now  that there seems to be a difference over the two doses.  Beware the enthusiastic !  And I am an enthusiast for Urso.  There’s also the Scandinavian study which we discussed before that clearly showed the difference between doses.  They used 18-22 mg/kg which is below our standard dose.  They’re doing a big high dose study in America (Mayo Clinic) five centres in the US are participating. Using a placebo group ..so I think you should be on Urso.
Q. On Urso and diarrhoea.

A.  Well we didn't see any diarrhoea with our high dose Urso patients. When we first started doing these trials people said you can't give people with Colitis high dose Urso ~ you just give them more bad diarrhoea. We saw more diarrhoea in the placebo group.
Sue. Some people said that initially they did get more diarrhoea but if they persisted for a few days it settled. Occasionally people do get diarrhoea but we don't think it's the effect of the Urso. With Colitis any change in medication can induce diarrhoea initially. One person had a rash but it was clearly not associated with Urso. There was no persistent pattern of side-effects ... ... this was over 2 years. Everybody seemed to tolerate really well and that was encouraging.
Q.  I have bi-annual colonoscopies. Should it be annually?
A.  Well there is a tradition here and in America and if you just have IBD ~ after eight years they start to give you a colonoscopy every two years. BUT with IBD & PSC the risk of colon cancer is markedly increased. There's no evidence, because it would be very difficult or impossible to do ~ but there is complete consensus throughout Europe, the UK and the US that you should have