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Primary sclerosing cholangitis with ulcerative colitis — ABIM Board MCQ

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HardGastroenterology/HepatologyPrimary sclerosing cholangitis with ulcerative colitisABIM Board

A 42-year-old man with ulcerative colitis has cholestatic liver enzyme elevation. MRCP shows multifocal stricturing and beading of intrahepatic and extrahepatic bile ducts. He is asymptomatic. Which of the following would you recommend?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Annual or frequent colonoscopic surveillance for colorectal neoplasia

Primary sclerosing cholangitis with ulcerative colitis markedly increases colorectal cancer risk and warrants regular colonoscopic surveillance from diagnosis, even when bowel symptoms are quiet.

Reference: AASLD Primary Sclerosing Cholangitis Guidance; ACG Ulcerative Colitis Guideline