Crohn's with high ALP...question regarding PSC

I am a 25 yr old male with crohn's disease. I apparently have had high ALP levels (130-150) for the past 3 years. They do not appear to be increasing. I had an MRCP done and i was told it indicated some inflation by my gastro doctor. She basically told me i had PSC. I had an ERCP scheduled and the doctors performing the procedure said that based on the MRCP they cannot make a diagnosis (it was too unclear) and the ERCP was being done to rule out psc. Based on the ERCP results they still cannot come to a conclusion. They did note some area of inflamation (inflammation) in my bile duct but cannot call is PSC. The inflammation was too minimal at this point. They said it MAY be early indications of psc but if i didn't have crohn's a PSC potential wouldn't be on the radar. The doctors performing the ERCP definitly painted me a much brighter picture than my gastro doctor and they seemed more positive at this point. I have had crohn's for 12 years and have had some arthiritic symptoms and have had a fistulae that was treated with cipro for year and has since been not treated for the past 2-3 years. I have no symptoms or pain. I am wondering what this could be if it is not PSC. COuld it be related to the fistulae or be a random swelling for no reason or what.

I have also had elevated ALP levels for 3 years and after the ERCP the situation in my bile duct does not seem serious at this point...thus whatever this is it appears to be very slow moving or not progressing. Could this inflammation stay as it is and not progress or regress? Even if it is PSC?

Sorry for the long windedness and mass of questions.

[Kevin Pho, MD]

The ERCP is normally a pretty good test to evaluate for PSC.  A liver biopsy can be considered for a more definitive diagnosis if the tests so far are inconclusive.

If you are clinically stable, with normal testing, the ALP can be serially monitored and observed.  Repeating the ERCP can be considered if the levels start rising, or if you start to develop more symptoms.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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