ursodeoxycholic acid / Generic mfg. - LARVOL DELTA

The Great Hepatic Mimicker: Hepatic Sarcoidosis Masquerading as TMP-SMX-Induced Cholestatic Liver Injury (ACG 2026) - "She was started on prednisone and TMP-SMX for Pneumocystis jirovecii prophylaxis...The patient was treated with high-dose corticosteroids and ursodeoxycholic acid...Early recognition is important because delayed diagnosis may result in progressive liver dysfunction and the need for liver transplantation. Figure: Progressive elevation of bilirubin and alkaline phosphatase despite withdrawal of TMP-SMX in biopsy-confirmed hepatic sarcoidosis."

Autoimmune Hepatitis • Cholestasis • Gastroenterology • Hepatology • Immunology • Inflammation • Liver Failure • Pulmonary Disease • Sarcoidosis

An Unusual Case of Portal Hypertension Caused by Hepatic Sarcoidosis (ACG 2026) - "His T. Bili was 3.2 mg/dL, D. Bili was 0.9 mg/dL, and INR was 2.9, likely due to warfarin...He was started on prednisone taper and azathioprine, but due to intolerance, was later switched to mycophenolate mofetil...Corticosteroids and ursodeoxycholic acid are commonly used. Refractory cases may require immunosuppressive agents such as azathioprine. Liver transplant should be considered in HS once complications of PH develop as survival rates at 1-year are 78%-84.6% and 5-year are 61%."

Clinical • Cardiovascular • CNS Disorders • Fibrosis • Hematological Disorders • Hematological Malignancies • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Lymphoma • Metabolic Dysfunction-Associated Steatotic Liver Disease • Portal Hypertension • Respiratory Diseases • Sarcoidosis • Thrombosis • Tuberculosis

Profound Hepatocellular Liver Injury in a 26-Year-Old With Concomitant Intrahepatic Cholestasis of Pregnancy (ICP): A Diagnostic Conundrum (ACG 2026) - "Course complicated by worsening LFTs (AST 203/ALT 489â AST 2,244 /ALT 2,725/ALP 175), impaired synthetic function (INR 1.5, albumin 2.7, T bilirubin 2.3) & BA elevation (99 µmol/L)...Given concerns for overlapping drug-induced liver injury (DILI) & intrahepatic cholestasis of pregnancy (ICP), ursodeoxycholic acid & N-acetylcysteine (NAC) were started...Amoxicillin-clavulanate is the most common cause of idiosyncratic DILI in the US and accounts for 11% of cases...D. Portal tracts showing no significant inflammation; favoring a non-infectious etiology"

Autoimmune Hepatitis • Cholestasis • Genetic Disorders • Gynecology • Hepatology • Immunology • Inflammation • Liver Failure • Urticaria • ABCB1

Vanishing Bile Duct Syndrome Associated With Hodgkin's Lymphoma (ACG 2026) - "She was treated with corticosteroids, ursodiol, and cholestyramine...Over the course of her chemotherapy regimen of cyclophosphamide followed by doxorubicin, her liver enzymes subsequently normalized over several weeks, supporting HL as the main driver of her VBDS...World journal of gastroenterology , 23 (2), 366-372. https://doi.org/10.3748/wjg.v23.i2.366"

Celiac Disease • Cholestasis • Hematological Malignancies • Hepatology • Hodgkin Lymphoma • Immunology • Infectious Disease • Liver Failure • Lymphoma

Intrahepatic Cholestasis of Pregnancy in a Patient With Underlying Mutations of ABCB4 and UGT1A1 (ACG 2026) - "This patient responded to Ursodiol Figure: Table 1. Serum bile acid levels during and between pregnancies demonstrating persistent elevation and partial response to ursodiol therapy."

Clinical • Cholestasis • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Pruritus • ABCB4 • UGT1A1 • UGT1A9

Autoimmune Hepatitis Presenting With Prominent Pruritus: The Critical Role of Liver Biopsy in the Community Setting (ACG 2026) - "AIH with cholestatic features can mimic primary biliary cholangitis (PBC) or AIH-PBC overlap- entities with distinct therapeutic implications, including ursodeoxycholic acid in overlap...Azathioprine was initiated Oct 6, 2025 (marker 8) following confirmed biochemical response to prednisone. Complete normalization of transaminases and bilirubin was achieved by May 2026. HD = hospital day; ULN = upper limit of normal."

Biopsy • Autoimmune Hepatitis • Cholestasis • Dermatology • Fibrosis • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Primary Biliary Cholangitis • Pruritus • Squamous Cell Carcinoma

A Potential Role for Dupilumab in Eosinophilic Cholangitis: A Novel Therapeutic Observation (ACG 2026) - "Due to reluctance to use corticosteroids, ursodiol was initiated with only mild ALP improvement and persistent pruritus. To our knowledge, there are no case reports describing its use for eosinophilic cholangitis due to its rarity. In our case, dupilumab was used for concomitant EoE and was associated with significant improvement in cholestatic liver enzymes and pruritus, marking one of the first cases describing dupilumab use in eosinophilic cholangitis, and highlighting a potential role for targeted IL-4/IL-13 blockade in this rare disease."

Asthma • Atopic Dermatitis • Biliary Cancer • Cholangiocarcinoma • Eosinophilia • Eosinophilic Esophagitis • Fibrosis • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hepatology • Immunology • Liver Cirrhosis • Primary Biliary Cholangitis • Primary Sclerosing Cholangitis • Pruritus • Rare Diseases • Respiratory Diseases • Solid Tumor • IL13 • IL4

Characteristics of Clinical Studies on Primary Biliary Cholangitis Registered in ClinicalTrials.gov: A Cross-Sectional Analysis (ACG 2026) - "Ursodeoxycholic acid (UDCA) remains first-line therapy, with obeticholic acid used for inadequate responders. Recent approvals of PPAR agonists seladelpar and elafibranor reflect a rapidly evolving therapeutic landscape... A total of 219 PBC studies were identified, representing 0.037% of 587,109 total CTG studies, with 63 (28.7%) ongoing. Of all PBC studies, 166 (75.8%) were interventional and 146 (66.7%) were pharmacological. Industry funding was significantly higher in PBC compared to all CTG (40.2% vs 28.1%; OR 1.73, 95% CI 1.32â2.26, p< 0.001), while NIH funding was significantly lower (3.7% vs 7.4%; OR 0.21, 95% CI 0.11â0.44, p< 0.001)."

Clinical • Cholestasis • Fibrosis • Hepatology • Immunology • Primary Biliary Cholangitis • Pruritus

Comparative Real-World Likelihood of Complete Alkaline Phosphatase Normalization With Obeticholic Acid Versus Elafibranor in Primary Biliary Cholangitis (ACG 2026) - "Introduction: In patients with Primary Biliary Cholangitis (PBC) who respond inadequately to first-line Ursodeoxycholic Acid (UDCA), reducing Alkaline Phosphatase (ALP) is essential to slowing disease progression. Propensity matching generated two balanced cohorts of 444 patients each (N=888 total). The post-match cohorts were identical in age (mean 61.3 vs. 61.2 years) and female sex (92.8% vs."

Clinical • Real-world • Real-world evidence • Hepatology • Immunology • Primary Biliary Cholangitis

Checkmate: A Case of Severe Refractory Immune Checkpoint Inhibitor Hepatitis (ACG 2026) - "Case Description/ A 54-year-old female with stage IC1 clear cell ovarian cancer with liver metastases was treated with lorigerlimab, a bispecific CTLA-4/PD-1 inhibitor, two months prior to presenting with elevated liver enzymes...She received methylprednisolone 100 mg daily for 3 days followed by outpatient prednisone taper for presumed ICI hepatitis...She was then started on IV methylprednisolone 60 mg twice daily and mycophenolate mofetil (MMF) 500 mg twice daily. Ursodiol was added for ductopenia...Figure: Figure 1. Liver Biopsy, hematoxylin and eosin stain, 400x magnification (A) Endothelialitis is shown with neutrophils and lymphocytes undermining and displacing the endothelial cells; (B) Zone 3 is present with lymphohistiocytic inflammation and mild sinusoidal dilation with congestion; (C) this portal tract lacks a primary bile duct concerning for bile duct loss, (D) Bile duct injury is shown characterized by vacuolization of the biliary epithelium with a few..."

Checkpoint inhibition • Clinical • Gastrointestinal Disorder • Hepatology • Inflammation • Liver Failure • Oncology • Ovarian Cancer • Ovarian Clear Cell Cancer • Solid Tumor

Triple Autoimmune Diagnosis at First Encounter: Concurrent Presentation of Primary Biliary Cholangitis, Sjögren's Syndrome, and Hashimoto's Thyroiditis (ACG 2026) - "Shared immunopathogenic mechanisms, including molecular mimicry, cross-reactive autoantibodies, and HLA associations, reinforce that PBC exists within a broader systemic autoimmune spectrum. This case underscores the importance of comprehensive inpatient autoimmune screening when PBC is first suspected, enabling timely initiation of ursodeoxycholic acid, levothyroxine, and sicca symptom management, while facilitating early transplant referral in advanced disease."

Endocrine Disorders • Fibrosis • Gastroenterology • Hematological Disorders • Hepatology • Immunology • Primary Biliary Cholangitis • Sjogren's Syndrome • Xerostomia

Unexplained Cholangiopathic Liver Fibrosis With Normal Cholangiography: A Case of Suspected Protoporphyria-Associated Liver Disease (ACG 2026) - "The patient was started on ursodeoxycholic acid and continues close hepatology follow-up...In patients with unexplained fibrosis, bile duct proliferation, and normal cholangiography, rare metabolic causes such as protoporphyria should remain in the differential. Histology may provide the key clue that leads to diagnosis when standard imaging and routine laboratory evaluation are unrevealing."

Clinical • Fibrosis • Genetic Disorders • Hematological Disorders • Hepatology • Immunology • Liver Cirrhosis • Liver Failure • Metabolic Disorders

Primary Sclerosing Cholangitis Preceding Crohn's Disease: Diagnostic Lessons From Persistent Liver Enzyme Elevation (ACG 2026) - "He was started on infliximab, azathioprine, and ursodiol. As PSC and liver enzyme activity do not correlate with IBD activity, improvement was likely due to ursodiol. This case emphasizes considering PSC in unexplained cholestatic injury even without gastrointestinal symptoms, as liver abnormalities may precede IBD diagnosis."

Autoimmune Hepatitis • Cholestasis • Crohn's disease • Cytomegalovirus Infection • Epstein-Barr Virus Infections • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatitis C • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Primary Sclerosing Cholangitis • Pruritus • Ulcerative Colitis

Post-Transplant Ursodiol and Increased PBC Recurrence: Real-World Evidence From TriNetX (ACG 2026) - "Before matching, 547 patients were in the non-UDCA cohort and 949 in the UDCA cohort. After PSM, 503 patients remained in each group with balanced baseline characteristics. PBC recurrence occurred in 34.8% of patients without UDCA versus 55.5% with UDCA."

Clinical • HEOR • Post-transplantation • Real-world • Real-world evidence • Hepatology • Immunology • Primary Biliary Cholangitis • Transplantation

Still Refluxing? Defining Mechanisms and the Role of Endoscopic Pyloric Exclusion in Stepwise Foregut Reconstruction (ACG 2026) - "He developed refractory reflux with frequent bilious emesis, positional reflux, and worsening oral intolerance despite multiple medical therapies including proton pump inhibitors (PPIs), sucralfate, and ursodeoxycholic acid. Figure: Figure 1: Serial Reconstruction of Foregut Anatomy Across Sequential Surgical and Endoscopic Interventions, starting from demonstration of gastroesophageal junction carcinoma (A), partial gastrectomy (B), gastrojejunal anastomosis and J-tube placement (C), Roux-en-Y reconstruction (D), and pyloric exclusion (E). Figure: Figure 2: HIDA-CT overlay demonstrating retrograde biliary flow from the duodenum into the stomach via the pylorus"

Barrett Esophagus • Gastric Cancer • Gastroesophageal Junction Adenocarcinoma • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Solid Tumor

Beyond the Bowel: Concurrent Pyoderma Gangrenosum and Primary Sclerosing Cholangitis in Ulcerative Colitis Successfully Managed With Tofacitinib in a Steroid-Intolerant Patient (ACG 2026) - "The patient was initiated on prednisolone 1 mg/kg/day, mesalamine 1.2 g three times daily, and ursodeoxycholic acid 300 mg twice daily, with initial clinical improvement. C. Five months after initiation of tofacitinib therapy Figure: MRCP image showing short-segment narrowing (green arrow) and dilatation (blue arrow) of both hepatic ducts and bilobar IHBRs, giving a beaded appearance in places."

Clinical • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Inflammatory Bowel Disease • Ophthalmology • Primary Sclerosing Cholangitis • Pyoderma Gangrenosum • Retinal Disorders • Ulcerative Colitis

Autoimmune Hepatitis-Primary Biliary Cholangitis Overlap Syndrome With Suspected Inflammatory Myopathy in an Octogenarian (ACG 2026) - "Prednisone was initiated in addition to ursodiol, resulting in rapid improvement in strength, appetite, labs, and functional status. This case underscores the importance of maintaining suspicion for autoimmune syndromes in elderly patients with unexplained liver injury and systemic manifestations. Figure: MRI with mild diffuse irregular intrahepatic biliary ductal dilation Figure: MRI with mild diffuse irregular intrahepatic biliary ductal dilation"

Autoimmune Hepatitis • Fibrosis • Gastroenterology • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Liver Failure • Myositis • Primary Biliary Cholangitis • PROS1

Managing Refractory ICI Hepatitis: Ursodiol as Salvage Therapy (ACG 2026) - "Case Description/ A 63-year-old male with recurrent metastatic NSCLC received 8 cycles of carboplatin/paclitaxel, followed by pembrolizumab and osimertinib...Despite IV methylprednisolone therapy for CIP, liver enzymes worsened (AST 388 U/L, ALT 410 U/L, ALP 337 U/L, and total bilirubin 3.4 mg/dL)...Due to steroid-refractory disease, mycophenolate mofetil was added, yielding a partial response before a rebound transaminitis occurred...Figure: Figure 1: The portal tracts show mixed inflammation with lymphocytes, neutrophils, rare plasma cells, and scattered eosinophils with preserved bile ducts. Figure: Figure 2: Foci of lobular inflammation with lymphocytes, ceroid laden histiocytes, rare plasma cells"

IO biomarker • Cardiovascular • Hepatitis C • Hepatology • Immunology • Infectious Disease • Inflammation • Lung Cancer • Non Small Cell Lung Cancer • Pneumonia • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Solid Tumor

A Complicated Case of Granulomatous Hepatitis (ACG 2026) - "Ursodiol 500 mg BID was started in addition to her post-transplant immunosuppressive regimen of sirolimus, tacrolimus, and prednisone with subsequent LFT improvement. This case highlights the complexity of granulomatous hepatitis and underscores the critical role of liver biopsy in diagnosis, management, and identification of underlying etiologies. Figure: Figure 2: Representative trichrome stain showing stage 3-4 fibrosis"

Clinical • CNS Disorders • Fibrosis • Hepatitis C • Hepatology • Idiopathic Arthritis • Immunology • Inflammation • Inflammatory Arthritis • Liver Cirrhosis • Liver Failure • Primary Biliary Cholangitis • Primary Immunodeficiency • Pulmonary Disease • Respiratory Diseases • Rheumatoid Arthritis • Sarcoidosis

Beyond the Bowel: Multi-Organ Dysfunction in Ulcerative Colitis-Systemic Lupus Erythematosus Overlap Syndrome With Ischemic Hepatitis and Disseminated Intravascular Coagulopathy (ACG 2026) - "She received broad-spectrum antibiotics, IV corticosteroids, N-acetylcysteine, ursodeoxycholic acid, vasopressor support, and blood products. Immunologic findings (ANA 1:140; anti-dsDNA 1:10; severely depressed C3 and C4) corroborate active SLE. ANA = antinuclear antibody; Anti-dsDNA = anti-double-stranded DNA antibody; APACHE II = Acute Physiology and Chronic Health Evaluation II; APTT = activated partial thromboplastin time; CRP = C-reactive protein; ECG = electrocardiography; FDP = fibrin degradation products; INR = international normalized ratio; POCUS = point-of-care ultrasound; RBC = red blood cells."

Acute Kidney Injury • Cardiovascular • CNS Disorders • Complement-mediated Rare Disorders • Endocrine Disorders • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Glomerulonephritis • Hematological Disorders • Hepatitis C • Hepatology • Immunology • Inflammation • Inflammatory Arthritis • Inflammatory Bowel Disease • Lupus • Lupus Nephritis • Nephrology • Ocular Inflammation • Ophthalmology • Renal Disease • Systemic Lupus Erythematosus • Ulcerative Colitis • Uveitis • CRP

Primary Biliary Cholangitis After Roux-en-Y Gastric Bypass: A Case Highlighting Diagnostic and Therapeutic Challenges in the Setting of Malabsorption (ACG 2026) - "Obeticholic acid 5 mg daily was initiated in 2016, resulting in biochemical improvement and symptom resolution... Malabsorption following Roux-en-Y gastric bypass can result in reduced circulating levels of ursodeoxycholic acid (UDCA), leading to suboptimal therapeutic response and posing a significant challenge in the management of primary biliary cholangitis (PBC)...Figure: Figure 2. Trend of liver enzymes in U/L (AST, ALT and Alkaline phosphatase) over time (in years)."

Bariatric surgery • Clinical • Barrett Esophagus • Cholestasis • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Primary Biliary Cholangitis • Pruritus

A Rare Culprit: Amoxicillin-Induced Seronegative Autoimmune Hepatitis (ACG 2026) - "While several drugs including amoxicillin-clavulanate have been reported to cause DILI, isolated amoxicillin-induced DI-AIH is exceedingly rare and not well-described...Ursodiol was discontinued on day 29 after biochemical improvement, and a gradual prednisone taper was initiated with reduction in prednisone by 10mg every week until discontinuation (purple-shaded region). Peak total bilirubin reached 17.9 mg/dL prior to therapy, followed by rapid improvement in bilirubin and liver enzyme levels after treatment initiation, with complete biochemical normalization during follow-up at 88 days. The temporal relationship between drug withdrawal, corticosteroid therapy, and sustained biochemical recovery supports the diagnosis of amoxicillin-induced seronegative drug-induced autoimmune hepatitis."

Autoimmune Hepatitis • Hepatocellular Cancer • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Pruritus • Solid Tumor

Drug-Induced Vanishing Bile Duct Syndrome Resembling Pancreaticobiliary Malignancy (ACG 2026) - "Cephalexin was thus permanently discontinued, and he improved on ursodeoxycholic acid (UDCA)...Because nitrofurantoin is structurally unrelated to cephalexin, this response suggests an idiosyncratic hypersensitivity to these antibiotics; his symptoms have since resolved with strict avoidance of all hepatotoxic medications...Figure: High-power (400Ã) view of a portal tract demonstrating ductopenia. The portal tract contains a small hepatic artery and portal vein; however, the bile duct is absent, consistent with loss of the interlobular bile duct."

Biliary Cancer • Cholangiocarcinoma • Cholestasis • Hepatology • Immunology • Infectious Disease • Liver Failure • Nephrology • Oncology • Solid Tumor

Uncommon Case of 6-Mercaptopurine-Induced Cholestatic Liver Injury With Vasculitic Rash (ACG 2026) - "She had been managed on 6-MP 50mg daily, prednisone 10mg daily, and ursodiol 900mg daily, and 6-MP dosage was recently doubled to 100mg daily due to rising liver enzymes. Figure: Left upper extremity with scattered violaceous petechiae with multiple confluent areas, a physical finding noted in 6-MP toxicity. Figure: Right upper extremity with scattered petechiae, from 6-MP toxicity-induced vasculitis."

Clinical • Autoimmune Hepatitis • Cholestasis • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Vasculitis

Evolving Treatment Strategies in Alagille Syndrome (ACG 2026) - "She was started on fat-soluble vitamins, ursodiol, hydroxyzine, and antihistamines for pruritus...After transferring care, maralixibat was recommended for continued pruritus, but the patient initially declined...Figure: Figure 2: Liver enzymes with persistently elevated AST, ALT, and GGT levels over time, consistent with ongoing cholestatic liver disease in the setting of Alagille syndrome. Liver enzymes have not been collected after initiation of odevixibat."

Cholestasis • Fibrosis • Hepatology • Immunology • Inflammation • Primary Biliary Cholangitis • Pruritus • JAG1 • NOTCH2