For example, because the bile doesn’t flow properly, it tends to result in something deposited in the brain.  This, very likely, causes the fatigue.  We are making some progress in this, and it may be possibly connected with manganese being the reason.  It is all provisional, and I haven’t analysed all the results yet.  This isn’t related to the stages of PSC.  You can have very mild PSC, normal LFTs, but still have bad fatigue.  It is a great conundrum as to why this should be.  Thirty five per cent of PBC patients will have such fatigue, perhaps a little less in PSC.  It can be disabling, and it appears not to be cured by transplantation.  Blocked bile ducts would certainly make things worse.

In answer to  a question from a patient about his gall bladder operation, Dr. Chapman said..... Any form of cholestatic disease will get an increase in gall stones in the gall bladder.  And some people with PSC will actually form sludge ~ pigment sludge within within the bile ducts themselves.  It’s not that uncommon, it does happen. This usually worsens any jaundice or fever.  It’s usually treated with a sphincterotomy ~ cutting the ends of the bile ducts, putting a balloon through and trying to remove the sludge.  The gall bladder can be involved in PSC ~  if you have a gall bladder with polyps, then the gall bladder is usually removed.

Q.  Does sunlight help with itching ?  I was on holiday in Spain, and the itching disappeared.
A.  That’s right ~ ultra-violet light (UV) does help.  But it’s a difficult thing to do on a regular basis and, as soon as you stop, the itching comes back.  So you have to keep going into the sunlight, which is an excuse for lots of holidays !!  There have been studies, and it does work.  But it’s not terribly practical.  A sun bed may be a good idea, but by and large, you can control itching with medication.    In PSC, you have to make sure that blocking in the bile ducts is not the cause of the itching.

Q.  How likely is it that PSC will come back after transplantation ?
A.  Quite high ~ we are talking about figures of around 25 to 30% after five years.  And probably 50% after ten years.  Some people will get it back without any problems, so it doesn’t mean that they have to be  re-transplanted necessarily.  But this does happen with other liver diseases, including PBC.

Q.  A question about the re-generation of the liver.
A.  Yes, it is true that the liver is an amazing organ.  It can re-generate even after severe damage.  Take away half of the liver, and it will grow back to its previous size.  There’s a story from the Greek classical legend about Prometheus.  He gave knowledge of fire to humans, and, as a punishment from Zeus, was placed on the top of a mountain.  Every day, an eagle would come and eat a piece of his liver.  But then, every day, the liver grew back again.  The Greeks knew about this.

Q.  A question about Professor Habib’s approach, in re-generating the liver by implanting stem cells.
A.  Professor Habib has taken several patients with very advanced liver disease, who may have required a liver transplant, and injected them with stem cells.  We were asked to take part in a trial, but we haven’t done so.  I can’t see that type of treatment used for PSC in the next ten years.