BIOPSY. As more damage to the bile ducts occurs,
symptoms intensify.
Medical interventions for primary sclerosing
cholangitis are primarily supportive and aim to
relieve symptoms such as PRURITIS (intense itch-
ing), which become more prominent as the condi-
tion progresses. The damage ultimately results in
CIRRHOSISand LIVER FAILURE. A significant risk dur-
ing this progression is cholangiocarcinoma, a can-
cerous tumor that develops in the inflamed bile
ducts. The course of the disease varies though
tends to run about 10 years from onset of symp-
toms to liver failure. The only curative treatment
is LIVER TRANSPLANTATION.
See also AUTOIMMUNE DISORDERS; BILIARY ATRESIA;
CANCER RISK FACTORS; GALLBLADDER DISEASE; PRIMARY
BILIARY CIRRHOSIS.
proctitis INFLAMMATIONof the RECTUMthat may
also involve the ANUS. A number of circumstances
may cause proctitis, including
- INFECTION, notably SEXUALLY TRANSMITTED DISEASES
(STDS) such as CHLAMYDIA, GONORRHEA, and GENI-
TAL HERPES - inflammatory conditions such asINFLAMMATORY
BOWEL DISEASE(IBD) and DIVERTICULAR DISEASE - trauma to the anus and rectum
- bacterial INFECTIONsecondary to chronic inflam-
mation or trauma - RADIATION THERAPY(radiation proctitis)
Symptoms include the continuous sensation of
needing to have a BOWEL MOVEMENT, CONSTIPATION,
and rectal discomfort or PAIN. The doctor can usu-
ally diagnose proctitis via proctoscopy (viewing
the anus and rectum endoscopically). Treatment
targets the cause, which may include ANTIBIOTIC
MEDICATIONSfor infections and CORTICOSTEROID MED-
ICATIONSor other anti-inflammatory products for
inflammation arising from trauma, radiation ther-
apy, and inflammatory conditions of the gastroin-
testinal tract.
See also ANAL FISSURE; ENDOSCOPY; HEMORRHOIDS.
proton pump inhibitor (PPI) medications Med-
ications that suppress gastric acid production in
the STOMACH. Commonly prescribed PPIs available
in the United States include- esomeprazole (Nexium)
- lansoprazole (Prevacid)
- omeprazole (Prilosec)
- pantoprazole (Protonix)
- rabeprazole (Aciphex)
How These Medications Work
PPIs work by blocking the enzyme system that
causes the parietal cells in the stomach’s lining
(gastric mucosa), called proton pumps, to produce
and release hydrochloric acid. PPIs can block up to
99 percent of gastric acid production. PPIs also
appear to slow the ability of HELICOBACTER PYLORI
bacteria to move, reducing their ability to cause
INFECTION. H. pyloriinfection is responsible for up
to 80 percent of ulcers.Therapeutic Applications
Doctors prescribe PPIs to treat PEPTIC ULCER DISEASE,
GASTROESOPHAGEAL REFLUX DISORDER (GERD), and
other conditions in which gastric acid becomes an
irritation that causes symptoms such as INFLAMMA-
TION and PAIN. PPIs are intended for relatively
short-term use, during the HEALINGphase of dam-
aged gastrointestinal mucosa. After healing is
complete, doctors recommend dietary modifica-
tions and H 2 ANTAGONIST(BLOCKER) MEDICATIONSor
ANTACIDSfor people who still need to suppress gas-
tric acid.Risks and Side Effects
PPIs have relatively few side effects or risks.
Among the most common are HEADACHE, dizziness,
fatigue, NAUSEA, ABDOMINAL PAIN, and DIARRHEA. No
one PPI is more likely than another to cause side
effects. Pregnant women should not take PPIs
because researchers do not yet know whether
these medications can harm the developing FETUS.
See alsoESOPHAGITIS; GASTRITIS; GASTROENTERITIS.proton pump inhibitor (PPI) medications 85