{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T10:32:33Z","timestamp":1786789953261,"version":"build-2736575974"},"reference-count":79,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T00:00:00Z","timestamp":1667347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Primary sclerosing cholangitis (PSC) is a progressive liver disease with poor prognosis and no effective therapies to prevent progression. An aetiopathological link between PSC and gastrointestinal microbial dysbiosis has been suggested.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate all potential medical therapies which may exert their effect in PSC by modulation of the gut\u2010liver axis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a\u00a0comprehensive scoping review of PubMed and Cochrane Library, including all articles evaluating an intervention aimed at manipulating the gastrointestinal microbiome in PSC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A wide range of therapies proposed altering the gastrointestinal microbiome for the treatment of PSC. In particular, these considered antibiotics including vancomycin, metronidazole, rifaximin, minocycline and azithromycin. However, few therapies have been investigated in randomised, placebo\u2010controlled trials. Vancomycin has been the most widely studied antibiotic, with improvement in alkaline phosphatase reported in two randomised controlled trials, but with no data on disease progression. Unlike antibiotics, strategies such as faecal microbiota transplantation and dietary therapy can improve microbial diversity. However, since these have only been tested in small numbers of patients, robust efficacy data are currently lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The gut\u2010liver axis is increasingly considered a potential target for the treatment of PSC. However, no therapies have been demonstrated to improve transplant\u2010free survival. Innovative and well\u2010designed clinical trials of microbiome\u2010targeted therapies with long\u2010term follow\u2010up are required for this orphan disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17251","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T05:18:47Z","timestamp":1667452727000},"page":"23-36","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Systematic review: microbial manipulation as therapy for primary sclerosing cholangitis"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9207-563X","authenticated-orcid":false,"given":"Damjana","family":"Bogatic","sequence":"first","affiliation":[{"name":"Department of Gastroenterology The Queen Elizabeth Hospital  Woodville South Australia Australia"},{"name":"Faculty of Health Sciences School of Medicine University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert V.","family":"Bryant","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Queen Elizabeth Hospital  Woodville South Australia Australia"},{"name":"Faculty of Health Sciences School of Medicine University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate D.","family":"Lynch","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences School of Medicine University of Adelaide  Adelaide South Australia Australia"},{"name":"IBD Service Department of Gastroenterology and Hepatology Royal Adelaide Hospital  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2857-1812","authenticated-orcid":false,"given":"Samuel P.","family":"Costello","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The 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