Refractory primary sclerosing cholangitis becoming responsive after sulphasalazine treatment of an underlying silent colitis

Primary sclerosing cholangitis is often unresponsive to treatment. It is still controversial whether the treatment of associated gastrointestinal conditions improves the course of liver disease. We report a case of refractory primary sclerosing cholangitis benefiting from sulphasalazine treatment, prescribed for a poorly symptomatic associated microscopic colitis. The usefulness of investigating the possible presence of a silent associated intestinal disease and the use of sulphasalazine in combination with ursodeoxycholic acid as a more effective treatment for normalizing serum hepatobiliary enzymes, are pointed out.