Background: Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system which damages the myelin and axon. Primary biliary cholangitis (PBC) is a slow progressive liver disease with autoimmune feature in which non-purulent destructive cholangitis and interlobular bile duct destruction occur. Involvement of each of PBC and MS is thought to be related to environmental exposure in genetically susceptible persons. Case Presentation: Here, we aim to report 3 women 52, 27 and 51 years old with MS and PBC. Conclusion: Although MS seems to have an association with some autoimmune gastrointestinal disorders such as ulcerative colitis, the concurrence of MS and PBC has been rarely reported.

Objective: There are several studies reporting the therapeutic effects of Berberis vulgaris on liver diseases. This study was done with the purpose of examining the effect of B. vulgaris oxymel (BO) in patients with refractory Primary sclerosing cholangitis (PSC) and Primary biliary cholangitis (PBC), who did not respond to current treatment. Materials and Methods: Patients with PSC or PBC who were receiving ursodeoxycholic acid (UDCA, 13-15 mg/kg/day) for at least six months, but their serum levels of alkaline phosphatase (ALP) were still 1. 5 folds higher than the normal upper limit during the last six months, were asked to participate in this quasi-experimental study. Patients were asked to take 0. 5 ml/kg/day of BO two times a day for three months along with UDCA. At the end of the study, serum levels of ALP, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), total bilirubin (TB), direct bilirubin (DB), and creatinine as well as prothrombin time (PT), international normalized ratio (INR) and quality of life (QOL) based on PBC-40 questionnaire were assessed as outcomes. Results: Our results showed that BO notably attenuated the serum levels of ALP, AST, ALT, GGT, TB, and DB, as well as PT and INR and significantly improved QOL. Conclusion: For first time, we showed that additional therapy with BO has a promising effect in the treatment of refractory PSC and PBC.

Background: Traditionally, Roux-en-Y hepaticojujenostomy was the method of choice for biliary reconstruction in Primary sclerosing cholangitis (PSC) in patients undergoing orthotopic liver transplantation.Objective: To compare the results of duct to duct anastomosis vs Roux-en-Y hepaticojujenostomy for biliary reconstruction in patients with PSC who underwent liver transplant in Shiraz Organ Transplant Center.Methods: We reviewed records of 69 patients with PSC who underwent liver transplant. We performed duct to duct reconstruction in those patients who had a grossly normal bile duct during hepatectomy (n=29). Roux-en-Y hepaticojujenostomy was used in the remaining 40 cases. Data collected included biliary complications (leakage, stricture, stone, and cancer in the remnant bile duct), documented episodes of rejection, and morbidity.Results: The studied patients had a mean follow-up of 27 (range: 9–46) months. In duct to duct group, 2 patients presented with anastomotic stricture and 1 developed cholangiocarcinoma in distal bile duct and underwent pancreaticoduodenectomy. In Roux-en-Y group, 5 patients developed anastomotic stricture in the follow-up. The difference was not significant. The rate of documented episodes of rejection was similar in the two groups (p=0.66).Conclusion: Duct to duct reconstruction is safe and can be the method of choice for biliary reconstruction in patients with PSC. Furthermore, considering the innovations in ERCP, management of strictures in duct to duct group can be easier and more feasible in comparison to revision of Roux-en-Y hepaticojujenostomy.