Role of intestinal flora in primary sclerosing cholangitis and its potential therapeutic value

Table 2 Intestinal flora regulation in primary sclerosing cholangitis treatment

Treatment			Results	Ref.
Oral Antibiotics	Vancomycin	125 mg four times daily for 90 d	Fecal calprotectin and serum GGT levels returned to normal	[94]
		125 mg four times daily for 12 wk	Significantly decreased ALP, MRS, ESR, and GGT levels. Fatigue, pruritus, diarrhea, and anorexia significantly improved	[91]
		50 mg/kg/d for 30 to 118 mo	Decreased ALT, AST, GGT, and ESR levels. Jaundice improved. The overall rate of positive serum autoantibodies decreased after 3.5 mo	[138]
	Vancomycin and metronidazole	Vancomycin: 125 mg or 250 mg four times daily for 12 wk; Metronidazole: 250 mg or 500 mg three times daily for 12 wk	Decreased ALP and MRS levels. The decrease in ALP level was more pronounced following vancomycin administration	[90]
	Metronidazole with ursodeoxycholic acid	Taken together for 36 mo	Significantly decreased ALP and MRS levels	[98]
	Azithromycin	500 mg three days per week for 6 wk	Decreased ALP and TBIL levels and cholestasis-related symptoms. The urine was turned dark in color again	[139]
	Rifaximin	550 mg twice daily for 12 wk	Decreased GGT and CRP levels; Improved pruritus symptoms	[95]
	Minocycline	100 mg twice daily for one year	Significantly decreased ALP and MRS levels	[100]
Fecal microbiota transplantation at 24 wk			Significantly decreased ALP levels; Reduced AST levels (by at least 30%)	[107]
Probiotics	Lactobacilli and Bifidobacteria	Three months of: Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus salivarius, and Lactococcus lactis, Bifidobacterium bifidum, Bifidobacterium	Reduced ALP levels (by 15%)	[113]
	Combined	Prednisolone (30 mg/d), salazosulfapyridine (3000 mg/d), and Lactobacillus casei Shirota (3 g/d) for 2 wk	Decreased ALP, ALT, AST, and GGT levels	[114]

ALP: Alkaline phosphatase; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; MRS: Mayo primary sclerosing cholangitis risk score; ESR: Erythrocyte sedimentation rate; GGT: Gamma-glutamyl transpeptidase; CRP: C-reactive protein; TBIL: Total bilirubin.