DOCTOR'S VIEW ARCHIVE

Walter Payton's Disease -- Primary Sclerosing Cholangitis

The American football legend Walter Payton, who has liver disease and needs a transplant, has reportedly taped a public service announcement promoting organ donation. The ad is scheduled to run during an episode of the television series "Touched By an Angel" on May 16, 1999. The theme of the episode is organ donation.

Mr. Payton, a remarkably talented and durable running back for the Chicago Bears, disclosed three months ago that he needed a liver transplant. The reason, he disclosed, was that he has primary sclerosing cholangitis.

Primary sclerosing cholangitis (PSC) is a chronic disorder of the liver in which the bile ducts outside the liver (the extrahepatic bile ducts) and often the bile ducts inside the liver (the intrahepatic bile ducts) become inflamed, thickened (sclerotic), narrowed, and finally obstructed. This is a progressive process that can in time destroy the bile ducts.

Primary sclerosing cholangitis is also commonly called idiopathic sclerosing cholangitis ("idiopathic" means the cause is unknown) or just sclerosing cholangitis.

The cause of sclerosing cholangitis is not known. PSC can occur in isolated form (by itself) or in association with other diseases, including:

  • Inflammatory bowel disease, especially with ulcerative colitis;
  • Certain uncommon diseases such as multifocal fibrosclerosis syndrome, Riedel's struma, and pseudotumor of the orbit; and
  • AIDS.

In AIDS, of course, the changes in the biliary tract are not of unknown origin (idiopathic), but are due to infection. The infectious agents include mycoplasma, cytomegalovirus, and others. Changes in the biliary tract are quite common in AIDS and are similar to those seen in PSC.