Low prevalence of primary sclerosing cholangitis in patients with inflammatory bowel disease in India

Background/Aims Primary sclerosing cholangitis (PSC) represents the most common hepatobiliary extraintestinal manifestation of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). Limited data exist on PSC in patients with IBD from India. We aimed to assess the prevalence and disease spectrum of PSC in Indian patients with IBD. Methods Database of IBD patients at 5 tertiary care IBD centers in India were analyzed retrospectively. Data were extracted and the prevalence of PSC-IBD was calculated. Results Forty-eight patients out of 12,216 patients with IBD (9,231 UC, 2,939 CD, and 46 IBD unclassified) were identified to have PSC, resulting in a prevalence of 0.39%. The UC to CD ratio was 7:1. Male sex and pancolitis (UC) or colonic CD were more commonly associated with PSC-IBD. The diagnosis of IBD preceded the diagnosis of PSC in most of the patients. Majority of the patients were symptomatic for liver disease at diagnosis. Eight patients (16.66%) developed cirrhosis, 5 patients (10.41%), all UC, developed malignancies (3 colorectal cancer [6.25%] and 2 cholangiocarcinoma [4.16%]), and 3 patients died (2 decompensated liver disease [4.16%] and 1 cholangiocarcinoma [2.08%]) on follow-up. None of the patients mandated surgical therapy for IBD. Conclusions Concomitant PSC in patients with IBD is uncommon in India and is associated with lower rates of development of malignancies.

[1]  G. Ramesh,et al.  Emerging inflammatory bowel disease demographics, phenotype, and treatment in South Asia, South‐East Asia, and Middle East: Preliminary findings from the Inflammatory Bowel Disease‐Emerging Nations' Consortium , 2022, Journal of gastroenterology and hepatology.

[2]  A. Memarnejadian,et al.  PSC associated inflammatory bowel disease: a distinct entity , 2022, Expert review of gastroenterology & hepatology.

[3]  E. Savarino,et al.  Prevalence of Primary Sclerosing Cholangitis in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. , 2021, Gastroenterology.

[4]  F. Hoentjen,et al.  Prognostic factors for advanced colorectal neoplasia in inflammatory bowel disease: systematic review and meta-analysis. , 2020, Gastroenterology.

[5]  Wendy S. Garrett,et al.  The gut microbiota and colon cancer , 2019, Science.

[6]  G. Alexander,et al.  British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis , 2019, Gut.

[7]  J. Stoker,et al.  ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. , 2018, Journal of Crohn's & colitis.

[8]  S. Pungpapong,et al.  Association between smoking and risk of primary sclerosing cholangitis: A systematic review and meta-analysis , 2018, United European gastroenterology journal.

[9]  S. Itzkowitz,et al.  Inflammatory Bowel Disease and Primary Sclerosing Cholangitis: A Review of the Phenotype and Associated Specific Features , 2017, Gut and liver.

[10]  V. Sreenivas,et al.  Long-term follow-up reveals high incidence of colorectal cancer in Indian patients with inflammatory bowel disease , 2017, United European gastroenterology journal.

[11]  T. Hadden,et al.  Bile acid: a potential inducer of colon cancer stem cells , 2016, Stem Cell Research & Therapy.

[12]  T. Karlsen,et al.  Prevalence of Sclerosing Cholangitis Detected by Magnetic Resonance Cholangiography in Patients With Long-term Inflammatory Bowel Disease. , 2016, Gastroenterology.

[13]  T. Karlsen.  Primary sclerosing cholangitis: 50 years of a gut–liver relationship and still no love? , 2016, Gut.

[14]  V. Sreenivas,et al.  Role of random biopsies in surveillance of dysplasia in ulcerative colitis patients with high risk of colorectal cancer , 2016, Intestinal research.

[15]  C. Constantinidou,et al.  The gut-adherent microbiota of PSC–IBD is distinct to that of IBD , 2016, Gut.

[16]  U. Navaneethan,et al.  Comparison of outcomes for patients with primary sclerosing cholangitis associated with ulcerative colitis and Crohn’s disease , 2014, Gastroenterology report.

[17]  D. Desai,et al.  Colorectal cancers in ulcerative colitis from a low-prevalence area for colon cancer. , 2015, World journal of gastroenterology.

[18]  S. Kedia,et al.  Extraintestinal manifestations of inflammatory bowel disease and intestinal tuberculosis: Frequency and relation with disease phenotype , 2015, Indian Journal of Gastroenterology.

[19]  S. Rai,et al.  Extraintestinal Manifestations of Inflammatory Bowel Disease and the Influence of Smoking , 2014, Digestion.

[20]  I. Kohane,et al.  Mortality and extraintestinal cancers in patients with primary sclerosing cholangitis and inflammatory bowel disease. , 2014, Journal of Crohn's & colitis.

[21]  K. Lindor,et al.  Inflammatory Bowel Disease in Primary Sclerosing Cholangitis: A Robust yet Changing Relationship , 2013, Inflammatory bowel diseases.

[22]  David C. Wilson,et al.  Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease , 2012, Nature.

[23]  R. Chapman,et al.  A unique clinical phenotype of primary sclerosing cholangitis associated with Crohn's disease. , 2012, Journal of Crohn's & colitis.

[24]  A. Bergquist,et al.  Increased Risk of Colorectal Cancer and Dysplasia in Patients With Crohn's Colitis and Primary Sclerosing Cholangitis , 2011, Diseases of the colon and rectum.

[25]  M. Manns,et al.  The challenges in primary sclerosing cholangitis--aetiopathogenesis, autoimmunity, management and malignancy. , 2008, Journal of hepatology.

[26]  G. Kaplan,et al.  The Burden of Large and Small Duct Primary Sclerosing Cholangitis in Adults and Children: A Population-Based Analysis , 2007, The American Journal of Gastroenterology.

[27]  E. Björnsson,et al.  Cholangiocarcinoma in Young Individuals With and Without Primary Sclerosing Cholangitis , 2007, The American Journal of Gastroenterology.

[28]  A. Zinsmeister,et al.  PSC-IBD: a unique form of inflammatory bowel disease associated with primary sclerosing cholangitis , 2004, Gut.

[29]  C. Benz,et al.  [Primary sclerosing cholangitis]. , 2000, Der Internist.

[30]  D. Adams,et al.  Homing of mucosal lymphocytes to the liver in the pathogenesis of hepatic complications of inflammatory bowel disease , 2002, The Lancet.

[31]  A. Ekbom,et al.  Is there an excess risk for colorectal cancer in patients with ulcerative colitis and concomitant primary sclerosing cholangitis? A population based study , 1997, Gut.

[32]  S. Lähde,et al.  Hepatobiliary and coexisting pancreatic duct abnormalities in patients with inflammatory bowel disease. , 1997, Scandinavian journal of gastroenterology.

[33]  H. Waldum.  Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis. , 1992, Journal of hepatology.

[34]  C. Gluud,et al.  Prevalence of hepatobiliary dysfunction in a regional group of patients with chronic inflammatory bowel disease. , 1991, Scandinavian journal of gastroenterology.

[35]  M. Hill.  Bile flow and colon cancer. , 1990, Mutation research.

[36]  R. Loe,et al.  SCLEROSING CHOLANGITIS; REVIEW OF RECENT CASE REPORTS AND ASSOCIATED DISEASES AND FOUR NEW CASES. , 1965, American journal of surgery.