International Journal of Colorectal Disease

, Volume 33, Issue 10, pp 1497–1500 | Cite as

Risk factors and clinical courses of concomitant primary sclerosing cholangitis and ulcerative colitis: a Korean multicenter study

  • Yong Eun Park
  • Jae Hee CheonEmail author
  • Jae Jun Park
  • Yoon Jae Kim
  • Chang Hwan Choi
  • Yehyun Park
  • Soo Jung Park
  • Tae Il Kim
  • Won Ho Kim
Short Communication



Primary sclerosing cholangitis (PSC) is a rare progressive cholestatic liver disease of unknown causes, but is strongly associated with inflammatory bowel diseases (IBDs), particularly ulcerative colitis (UC). However, studies comparing risk factors and clinical courses of patients with concomitant UC and PSC with those of patients with PSC alone are lacking.


We retrospectively reviewed patients with PSC diagnosed between 2005 and 2017 in four tertiary hospitals in Korea. We compared the risk factors and outcomes of concomitant UC and PSC (UC-PSC) and those of PSC alone.


PSC was diagnosed in 50 patients in four different tertiary hospitals in Korea. Of them, 18 patients (36.0%) had UC-PSC and 32 patients (64.0%) had PSC alone. The median age at PSC diagnosis was younger in the UC-PSC group than that in the PSC alone group (37 vs. 54 years, P = 0.002). In multivariate analysis, older age at PSC diagnosis (P = 0.007; odds ratio [OR], 0.884; 95% confidence interval [CI], 0.808–0.966) and current smoking habit (P = 0.033; OR, 0.026; 95% CI, 0.001–0.748) were determined to be independent factors for reducing the possibility of developing concomitant UC after PSC. Additionally, UC-PSC was shown to be an independent risk factor for the development of colorectal dysplasia (P = 0.044; OR, 10.829; 95% CI, 1.065–110.127).


Our analysis showed that UC-PSC is more likely to be negatively associated with current smoking and older age at the time of PSC diagnosis. Moreover, UC-PSC increased the risk of colorectal dysplasia.


Primary sclerosing cholangitis Ulcerative colitis Inflammatory bowel disease Risk factor Outcome assessment 


Specific author contributions

Yong Eun Park: acquisition of data; analysis and interpretation of data; drafting of the manuscript. Jae Jun Park: acquisition of data; study concept and design. Yoon Jae Kim: acquisition of data; study concept and design. Chang Hwan Choi: acquisition of data; study concept and design. Yehyun Park: study concept and design; critical revision of the manuscript for important intellectual content. Soo Jung Park: study concept and design; critical revision of the manuscript for important intellectual content. Tae Il Kim: study concept and design; critical revision of the manuscript for important intellectual content. Won Ho Kim: study concept and design; critical revision of the manuscript for important intellectual content. Jae Hee Cheon: acquisition of data; study concept and design; critical revision of the manuscript for important intellectual content. All authors approved the final version of the article, including the authorship list.

Source of funding

This research was supported by a grant (NRF-2017R1A1A1A05001011) from the Basic Science Research Program through the National Research Foundation of Korea, which is funded by the Ministry of Science, ICT and Future Planning.

Compliance with ethical standards

This study was performed in accordance with the ethical guidelines of the 1975 Declaration of Helsinki and approved by the Institutional Review Board of Severance Hospital.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Lazaridis KN, LaRusso NF (2016) Primary sclerosing cholangitis. N Engl J Med 375(12):1161–1170CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Hirschfield GM, Karlsen TH, Lindor KD, Adams DH (2013) Primary sclerosing cholangitis. Lancet 382(9904):1587–1599CrossRefPubMedGoogle Scholar
  3. 3.
    Palmela C, Peerani F, Castaneda D, Torres J, Itzkowitz SH (2018) Inflammatory bowel disease and primary sclerosing cholangitis: a review of the phenotype and associated specific features. Gut Liver 12(1):17–29CrossRefPubMedGoogle Scholar
  4. 4.
    Lazaridis KN, LaRusso NF (2016) Primary sclerosing cholangitis. N Engl J Med 375(25):2501–2502PubMedGoogle Scholar
  5. 5.
    Boonstra K, van Erpecum KJ, van Nieuwkerk KM, Drenth JP, Poen AC, Witteman BJ, Tuynman HA, Beuers U, Ponsioen CY (2012) Primary sclerosing cholangitis is associated with a distinct phenotype of inflammatory bowel disease. Inflamm Bowel Dis 18(12):2270–2276CrossRefPubMedGoogle Scholar
  6. 6.
    Boberg KM, Aadland E, Jahnsen J, Raknerud N, Stiris M, Bell H (1998) Incidence and prevalence of primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis in a Norwegian population. Scand J Gastroenterol 33(1):99–103CrossRefPubMedGoogle Scholar
  7. 7.
    Kaplan GG, Laupland KB, Butzner D, Urbanski SJ, Lee SS (2007) The burden of large and small duct primary sclerosing cholangitis in adults and children: a population-based analysis. Am J Gastroenterol 102(5):1042–1049CrossRefPubMedGoogle Scholar
  8. 8.
    Hashimoto E, Ideta M, Taniai M, Watanabe U, Okuda H, Nagasako K, Hisamitsu T, Obata H (1993) Prevalence of primary sclerosing cholangitis and other liver diseases in Japanese patients with chronic ulcerative colitis. J Gastroenterol Hepatol 8(2):146–149CrossRefPubMedGoogle Scholar
  9. 9.
    Ye BD, Yang SK, Boo SJ, Cho YK, Yang DH, Yoon SM, Kim KJ, Byeon JS, Myung SJ, Yu CS, Yun SC, Kim JH (2011) Clinical characteristics of ulcerative colitis associated with primary sclerosing cholangitis in Korea. Inflamm Bowel Dis 17(9):1901–1906CrossRefPubMedGoogle Scholar
  10. 10.
    Fraga M, Fournier N, Safroneeva E, Pittet V, Godat S, Straumann A, Nydegger A, Vavricka SR, Moradpour D, Schoepfer AM (2017) Primary sclerosing cholangitis in the Swiss Inflammatory Bowel Disease Cohort Study: prevalence, risk factors, and long-term follow-up. Eur J Gastroenterol Hepatol 29(1):91–97CrossRefPubMedGoogle Scholar
  11. 11.
    Ludwig J, Barham SS, LaRusso NF, Elveback LR, Wiesner RH, McCall JT (1981) Morphologic features of chronic hepatitis associated with primary sclerosing cholangitis and chronic ulcerative colitis. Hepatology 1(6):632–640CrossRefPubMedGoogle Scholar
  12. 12.
    Glowacki MK, Zwolinska-Wcislo M, Fraczek P, Gomulska M, Owczarek D, Cibor D, Ciesla A, Mach T (2015) Clinical course of primary sclerosing cholangitis and concomitant ulcerative colitis—a preliminary report of retrospective study among patients from Southern Poland. Folia Med Cracov 55(2):61–68PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yong Eun Park
    • 1
    • 2
  • Jae Hee Cheon
    • 1
    • 3
    Email author
  • Jae Jun Park
    • 4
  • Yoon Jae Kim
    • 5
  • Chang Hwan Choi
    • 6
  • Yehyun Park
    • 1
    • 3
  • Soo Jung Park
    • 1
    • 3
  • Tae Il Kim
    • 1
    • 3
  • Won Ho Kim
    • 1
    • 3
  1. 1.Department of Internal MedicineYonsei University College of MedicineSeoulKorea
  2. 2.Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
  3. 3.Institute of GastroenterologyYonsei University College of MedicineSeoulKorea
  4. 4.Department of Internal Medicine, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
  5. 5.Department of GastroenterologyGachon University, Gil Medical CenterIncheonKorea
  6. 6.Department of Internal MedicineChung-Ang University College of MedicineSeoulKorea

Personalised recommendations