Spontaneous course of symptoms in primary sclerosing cholangitis: Relationships with biochemical and histological features

An analysis was made of the symptom diaries of 65 patients with primary scl erosing cholangitis (PSC) who recorded their symptoms of itching, pain and fever during a 3 year period. Symptoms occurred in 84 % of the patients, with considerable individual var iations in symptom load. Symptoms were usually intermittent. "Itching only" and "pain only" were the most frequent episode features. Most episodes las ted only 1-2 days. Fever seemed to be the most embarrassing symptom. Apart from close correlations between pruritus and serum ALP levels, there were n o significant correlations between the symptom load and serum biochemistry or eleven different histological features. Even daily symptoms over a perio d of several months could disappear spontaneously. We conclude that most symptom episodes in PSC are mono-symptomatic and brie f. Biochemical or histological data do not predict the appearance of sympto ms.