Oral vancomycin induces clinical and mucosal remission of colitis in children with primary sclerosing cholangitis-ulcerative colitis

The report by Kummen et al1 describing differences in gut microbial profile in patients with primary sclerosing cholangitis (PSC) and primary sclerosing cholangitis–ulcerative colitis (PSC–UC) compared with healthy controls and patients with UC without liver disease supports the tantalising prospect of microbiome manipulation as therapy for these conditions. The role of antibiotics in this setting, particularly in UC, is of great current interest2; The use of oral vancomycin (OV) for treatment of PSC was first reported by Cox and Cox3 in 1998, the focus then was treatment of liver disease, although it remains unclear if OV affects liver outcomes in PSC. We did, however, become interested in the description of improved clinical and endoscopic colitis in children with UC associated with PSC.Although typically mild, the colitis of PSC–UC or autoimmune sclerosing cholangitis–ulcerative colitis (ASC–UC) can be severe and resistant to conventional UC therapy. Active colitis in those...

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