{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T11:35:26Z","timestamp":1773920126028,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Gastroenterol"],"accepted":{"date-parts":[[2018,10,25]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>The gut\u2013liver axis describes the complex interactions between gut microbiota, the small and large bowel, the immune system and the liver. Current evidence associates abnormalities within the gut\u2013liver axis with liver disease such as primary sclerosing cholangitis (PSC). PSC is believed to be an immune-mediated disease though the exact mechanism of its pathogenesis remains unknown. Here, we report a case of a 66 -year-old woman with treatment-resistant ulcerative colitis and PSC which continued to be active following subtotal colectomy. Interestingly, her PSC achieved full remission after proctectomy for treatment-resistant proctitis in the rectal stump. This case report supports existing hypotheses that PSC is an immune-mediated disease triggered by antigens within the gut. More notably, it suggests the yet unidentified pathogens may be localised to the lower gastrointestinal tract including the rectum.<\/jats:p>","DOI":"10.1136\/bmjgast-2018-000239","type":"journal-article","created":{"date-parts":[[2018,11,15]],"date-time":"2018-11-15T05:14:42Z","timestamp":1542258882000},"page":"e000239","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Interference with the lower gut\u2013liver axis induces remission of primary sclerosing cholangitis in a patient with ulcerative colitis"],"prefix":"10.1136","volume":"5","clinical-trial-number":[{"clinical-trial-number":"nct02424175","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5103-7311","authenticated-orcid":false,"given":"John","family":"Ong","sequence":"first","affiliation":[{"name":"Department of Engineering, University of Cambridge, Cambridge, UK"},{"name":"Department of Gastroenterology, Bedford Hospital South Wing, Bedford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leila","family":"Mebarek","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Bedford Hospital South Wing, Bedford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Bath","sequence":"additional","affiliation":[{"name":"Department of Surgery, Addenbrooke's Cambridge University Hospital, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Swift","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Addenbrooke's Cambridge University Hospital, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babur","family":"Javaid","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Bedford Hospital South Wing, Bedford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenish","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Bedford Hospital South Wing, Bedford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasseen","family":"Al-Naeeb","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Bedford Hospital South Wing, Bedford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,11,14]]},"reference":[{"key":"2025073013070963000_5.1.e000239.1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/BF02912537","article-title":"IgA antibodies to dietary antigens in liver cirrhosis","volume":"17","author":"Volta","year":"1987","journal-title":"Ric Clin Lab"},{"key":"2025073013070963000_5.1.e000239.2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e318284abb5"},{"key":"2025073013070963000_5.1.e000239.3","doi-asserted-by":"crossref","unstructured":"Tripathi A . The gut-liver axis and the intersection with the microbiome. 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