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The impact of ulcerative colitis on the long‐term outcome of patients with primary sclerosing cholangitis
Author(s) -
Navaneethan U.,
Venkatesh P. G. K.,
Lashner B. A.,
Shen B.,
Kiran R. P.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2012.05063.x
Subject(s) - medicine , primary sclerosing cholangitis , ulcerative colitis , gastroenterology , hazard ratio , liver transplantation , confidence interval , transplantation , disease
Summary Background The impact of ulcerative colitis ( UC ) on the outcome of primary sclerosing cholangitis ( PSC ) outcome remains unclear. Aim To investigate whether the presence of UC is associated with a worse clinical of associated PSC . Methods A total of 222 patients with PSC (167 with UC and 55 without UC ) seen and followed at a single centre from 1985 to 2011 were included. Clinical and demographic variables were obtained and patients were followed until the date of their last clinic visit. Results The median age at presentation of PSC with associated UC was 38 vs. 47 years without UC ( P < 0.001). At presentation, median serum bilirubin (2.1 vs. 4.5, P < 0.001) and the Mayo PSC Risk Score (0.95 vs. 1.69, P < 0.001) were lower in those with UC vs. those without UC . A total of 55 of 167 (32.9%) patients with PSC ‐ UC developed colon neoplasia in contrast to 1 of the 55 (1.8%) patients with PSC . ( P < 0.001) On proportional hazards analysis, UC (hazard ratio ( HR ) = 0.90 [95% confidence interval (CI): 0.60–1.34, P = 0.60] was not associated with death or orthotopic liver transplantation ( OLT ), when adjusting for gender, Mayo risk score and year of PSC diagnosis; whereas the revised Mayo risk score [ HR = 5.08, 95% CI : (2.62–9.86), P < 0.001] was associated with a greater risk of OLT or death. Conclusions Primary sclerosing cholangitis often is recognised at an early stage in patients with concurrent ulcerative colitis ; ulcerative colitis has no impact on long‐term prognosis in terms of liver‐related outcomes when adjusted for the severity of liver disease.