Bugs in Bile: A Fly in the Ointment?

Primary sclerosing cholangitis (PSC) is the archetypal disease of the gut-liver axis in which colonic inflammation, through as yet undefined mechanisms, leads to biliary inflammation, fibrosis, and chronic cholestasis. A role for gut and biliary microbes in PSC has long been postulated. Several animal models in which bacteria or their products are administered into the gut lead to biliary disease.