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Risk factors for primary sclerosing cholangitis
Author(s) -
Boonstra Kirsten,
Vries Elisabeth M. G.,
Geloven Nan,
Erpecum Karel J.,
Spanier Marcel,
Poen Alexander C.,
Nieuwkerk Carin M.,
Witteman Ben J.,
Tuynman Hans A.,
Naber Anton H.,
Kingma Paul J.,
Beuers Ulrich,
Ponsioen Cyriel Y.
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12894
Subject(s) - primary sclerosing cholangitis , medicine , gastroenterology , ulcerative colitis , inflammatory bowel disease , family history , population , incidence (geometry) , case control study , liver disease , disease , cohort , autoimmune hepatitis , environmental health , physics , optics
Abstract Background & Aims Primary sclerosing cholangitis ( PSC ) is a progressive cholestatic liver disease of unknown cause, but strongly associated with inflammatory bowel disease ( IBD ). Potential risk factors triggering PSC have never been studied on a population level. The aim of this study was to evaluate smoking, appendectomy, family history and geographical distribution in a population‐based cohort of PSC patients, as compared to IBD control patients and healthy controls ( HC ). Methods For this case–control study 343 PSC patients, 370 IBD controls and 232 HC 's living in a geographically defined area in the Netherlands filled‐out a questionnaire concerning smoking, appendectomy and family history of IBD and autoimmune liver diseases. Results Smoking was associated with a lower risk of developing PSC in PSC ‐ulcerative colitis ( UC ) patients (adjusted OR 0.21; 95% CI 0.12–0.34; P < 0.001). Comparable results were found for PSC ‐Crohn's disease ( CD ) patients (16% former smokers) compared to CD patients (55% former smokers) (adjusted OR 0.17; 95% CI 0.08–0.39; P < 0.001). Frequency of appendectomy did not differ between PSC and HC , but PSC ‐ UC patients had undergone appendectomy more often than UC patients (13% vs. 6%) (adjusted OR 2.51; 95% CI 1.04–6.07; P = 0.041). We found no association between family history of IBD or autoimmune liver disease and risk of PSC . Degree of urbanization was not associated with PSC incidence. Conclusion In this large population‐based case–control study we confirm that smoking is associated with a lower risk of developing PSC , independent of its protective effect for developing UC . Appendectomy is not associated with the risk of developing PSC .