Real-Life Management of Primary Sclerosing Cholangitis and Primary Sclerosing Cholangitis–Inflammatory Bowel Disease: Integrating Liver and Bowel Care

Primary sclerosing cholangitis (PSC) remains without an approved medical therapy, leaving clinicians to navigate highly variable and often conflicting real-world practices. Many patients receive ursodiol; others receive oral vancomycin (OV), and bowel-directed therapies that are inconsistently integrated despite strong evidence that PSC is a gut-liver axis disease. This session provides a practical, case-based update on how PSC and PSC with inflammatory bowel disease (PSC–IBD) are currently managed in real clinical settings across hepatology, inflammatory bowel disease (IBD), and pediatrics. Faculty review: How, when, and whether ursodiol is used in practice Evidence and mechanisms behind OV therapy—including dosing strategies, absorption/formulation issues, relapse with discontinuation, subgroup differences, and common misuse Management of IBD in persons with PSC including key considerations and the best options for treatment The session emphasizes real-life decision-making, areas of persistent disagreement, and points of consensus emerging across hepatology and gastroenterology with the goal of equipping clinicians with practical, patient-centered guidance that they can immediately apply.