Primary Sclerosing Cholangitis (PSC) and UC: What the Link Means and What Gets Monitored
Last Updated Jan 15, 2026
Primary sclerosing cholangitis (PSC) is a liver and bile-duct condition that shows up more often in people living with ulcerative colitis (UC) than in the general population. Because PSC can affect long-term risks (including certain cancers) and can change what gets monitored, many care plans look different once PSC ulcerative colitis is part of the picture. The goal is usually coordinated care between gastroenterology (for UC) and hepatology (for the liver and bile ducts), with a clear plan for labs, imaging, and colon checks.
Understanding PSC in the context of ulcerative colitis
PSC is a long-term disease where bile ducts become inflamed, scarred, and narrowed over time, which can interfere with bile flow and gradually damage the liver. PSC is closely linked with inflammatory bowel disease, especially UC, and may be found during routine testing even when bowel symptoms feel controlled. Many people have no symptoms at first, but common PSC symptoms can include fatigue, itching, belly pain, diarrhea, fevers (sometimes tied to repeat bile-duct infections), and jaundice (yellowing of the skin or eyes). [1]
The PSC and UC connection is important, even though PSC itself is still uncommon among people with UC. A large systematic review and meta-analysis estimated the pooled prevalence of PSC in ulcerative colitis at about 2.5%, meaning most people with UC will never develop PSC. [2]
When PSC and UC occur together, the bowel disease can be harder to “judge” by symptoms alone. UC may be quiet on the surface while still involving a large portion of the colon. This is one reason PSC screening UC topics often focus on regular monitoring rather than waiting for obvious warning signs. PSC can also be associated with episodes of cholangitis (infection in the bile ducts), which is a separate issue from colitis flares but can feel urgent and intense.
What gets monitored when PSC and UC overlap
Monitoring plans vary, but they often become more structured once PSC is diagnosed because both liver health and cancer risk can change. One common starting point is lab work. Clinicians often follow “liver enzymes” and related blood tests over time, because PSC may first show up as abnormal liver tests. Imaging is also central to diagnosis and follow-up, with magnetic resonance cholangiopancreatography (MRCP), a special magnetic resonance imaging (MRI) scan of the bile ducts, often used to evaluate the bile ducts, along with liver blood tests such as alkaline phosphatase. [3]
Cancer surveillance is another major reason monitoring changes. Expert guidance from the American Gastroenterological Association (AGA) notes that surveillance for cholangiocarcinoma (bile duct cancer) and gallbladder cancer should be considered in adults with PSC, and suggests imaging (ultrasound, computed tomography, or MRI), with or without a blood marker called carbohydrate antigen 19-9 (CA 19-9), every 6 to 12 months. [4]
For the colon, the colon cancer risk PSC UC combination is treated as higher risk in many guidelines. The American College of Gastroenterology (ACG) guideline for ulcerative colitis states that people with UC and PSC should have a screening colonoscopy at the time of UC diagnosis and then have surveillance annually. [5]
PSC is also recognized by liver societies as a condition that increases the risk of cholangiocarcinoma and colorectal cancer, which helps explain why follow-up can feel more intensive than UC alone. [6]
Questions that can help clarify a PSC screening UC plan with a gastroenterologist and hepatologist include:
- Which liver enzymes and other labs are being tracked, and what changes matter most?
- Which imaging test is preferred (ultrasound, MRI/MRCP), and how often is it used?
- How is cholangitis UC risk discussed, and what symptoms raise concern?
- What is the colonoscopy schedule, and how does it relate to colon cancer risk PSC UC?
- Are there additional checks related to long-term liver disease (such as nutrition or bone health monitoring)?