Unraveling the Mechanisms Underlying Primary Sclerosing Cholangitis Through a Multidisciplinary, Integrative Research Approach

Eligibility Criteria

• 1. Stated willingness to comply with all study procedures and availability for the duration of the study
• 2. Male or nonpregnant female, greater than or equal to 18 years of age
• 3. Evidence of PSC established by biochemical testing and either MRCP or ERCP. Participant must have evidence of large duct disease on imaging.
• 4. Agreement to adhere to Lifestyle Considerations throughout study duration.
• 1. Pregnant or lactating women or females of child-bearing age not taking measures to prevent pregnancy during the period of study.
• 2. History of clinical, serologic, or histopathologic evidence supporting etiologies of chronic liver disease other than PSC
• 3. History of liver transplantation
• 4. Diagnosis consistent with secondary sclerosing cholangitis (cholelithiasis, bile duct strictures secondary to ischemia, HIV cholangiopathy, etc.).
• 5. Current or past clinical evidence of decompensated liver disease (e.g. ascites, bleeding esophageal varices, spontaneous bacterial peritonitis, encephalopathy, etc.).
• 6. History of liver or bile duct lesions concerning for malignancy.
• 7. Ca-19-9 \>130 U/microL
• 8. Alpha-fetoprotein level greater than 200 ng/microL.
• 9. Patients with active bacterial, viral, or fungal, systemic or localized infection.
• 10. Unwillingness to refrain from ingesting probiotics during study.
• 11. History of systemic disease not related to PSC that is poorly controlled or associated with declining functional status. Examples include but are not limited to: poorly controlled diabetes mellitus, chronic renal failure with eGFR is \<60 microl/min/1.73m\^2, chronic
• 12. Patients with history of any gastrointestinal malignancy in the last 3 years prior to enrollment will be excluded. Patients with history of any malignancy in the last 3 years prior to enrollment other than those individuals who had undergone curative surgical therapy and deemed as low risk for recurrence by her/his treating physician would be excluded.
• 13. History of portal vein thrombosis
• 14. Patients with severe allergic reactions to iodine or other contrast, which cannot be controlled by premedication with antihistamines or steroids.
• 15. History of gastric and/or proximal small bowel surgery including bariatric surgery such as Roux-en-Y gastric bypass
• 16. Contraindication to monitored anesthesia care and/or medications that are commonly used for conscious sedation during GI Endoscopy
• 17. Use of anti-coagulant and anti-platelet agents excluding aspirin and NSAIDs
• 18. Contraindications to completing MRCP or MRI
• 19. Absolute neutrophil count below 1000/mm\^3
• 20. Hemoglobin level below 10.0 g/dl
• 21. Platelet count lower than 50,000/mm\^3.
• 22. INR greater than or equal to 1.5, PTT greater thna or equal to 1.3 times control and/or any known history of disease associated with
• 23. Inability to provide informed consent