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Various absorbable/systemic and non-absorbable antibiotics may act via modulation of gut microbiota and have shown to improve liver biochemistry in PSC, with vancomycin as one of the most promising agents.59 Probiotics have been rather disappointing in treatment of NASH60 and cholestatic disorders such as PSC,61 but faecal microbiota transplantation from lean donors improves insulin resistance in individuals with metabolic syndrome62 and has shown first promising results in PSC.63 Importantly, gut microbiota may not only serve as a trigger of liver injury but may also have protective actions