Autoimmune Sclerosing Cholangitis (ASC), also known as overlap syndrome, refers to an autoimmune condition with immunological, clinical and histological factors of both autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC). ASC patients present with a combination of clinical findings typically seen in either AIH or PSC. For instance, these patients would present with serum auto-antibodies (usually seen in AIH) and concomitant presence of bile duct abnormalities by MRCP (which is suggestive of PSC).

Causes of ASC

The cause is not fully understood, however it is thought that ASC may be caused by an immune reaction to an infectious trigger. Genetic factors are also believed to play a role.

Symptoms of ASC

Common initial symptoms include:

  • Fatigue
  • Itching
  • Jaundice
  • Diarrhea
  • Weight loss
  • Abdominal pain
  • An enlarged liver
  • Loss of appetite
  • Dark-colored urine, light colored stools

Treatment of ACS

In ASC (an overlap of AIH and PSC), corticosteroid administration may be started if autoimmune features are predominant. Some patients may experience improvement when started on ursodeoxycholic acid. Alterations in treatment are dictated by the changes in disease characteristics and suitability of the patient’s response.