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Factors associated with major radiological progression of primary sclerosing cholangitis in patients with inflammatory bowel disease

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Abstract

Background/purpose of the study

Primary sclerosing cholangitis (PSC) is the most common hepatobiliary manifestation of inflammatory bowel disease (IBD). Magnetic resonance cholangiography (MRC) has become the primary diagnostic modality for PSC. However, data on radiological progression over time of large-duct PSC–IBD are limited.

Methods

We performed a nested case–control study to estimate the frequency of PSC in adult patients with IBD from a Middle Eastern population to assess the risk factors associated with major disease progression (formation of dominant strictures or cholangiocarcinoma) over time.

Results

Data of IBD patients who were registered in the Saudi IBD Information System at tertiary care center were analyzed. Among 960 patients [477 ulcerative colitis (UC); 483 Crohn’s disease (CD)], 40 PSC–IBD patients with at least two MRC performed in a one-year interval were matched with 141 IBD patients without PSC. The frequency of PSC was 4.1%. UC patients (6.2%) compared to CD (2%), 65% had extensive colitis. The incidence rate of PSC among our cohort was increased from 2.62 to 10 per 1000 patient-years between 2005 and 2019. MRC features stabilized in (46.7%); worsened in (36.9%) and 15.4% of patients developed CCA. Alkaline phosphatase (ALP) levels of PSC patients who had major changes or CCA increased significantly after 44 months of follow-up (p = 0.01). The propensity score adjusted showed that hospitalization rate among PSC patients was higher than their non-PSC counterparts (OR 8.24; 95% CI 3.16–21.47; p < 0.01).

Conclusion

ALP rise and hospitalization history as clinical outcome were the only factors associated with PSC–IBD major progression on MRCP.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, King Saud University Medical City, King Saud University, Po Box 2925, 12372, Riyadh, Kingdom of Saudi Arabia

    Nahla Azzam, Othman Alharbi, Abdulrahman Aljebreen & Majid Almadi

  2. Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Po Box 2925, 12372, Riyadh, Kingdom of Saudi Arabia

    Yazed AlRuthia

  3. Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Po Box 2925, 12372, Riyadh, Kingdom of Saudi Arabia

    Yazed AlRuthia

  4. Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, 1001 Decarie Blvd, Montreal, QC, H4A3J1, Canada

    Majid Almadi

  5. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA

    Edward V. Loftus Jr.

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  1. Nahla Azzam
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  2. Yazed AlRuthia
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Correspondence to Nahla Azzam.

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Conflict of interest

Nahla Azzamdeclares that she has no conflict of interest or financial disclosure. Yazed AlRuthia declares that he has no conflict of interest or financial disclosure. Othman Alharbideclares that he has no conflict of interest or financial disclosure. AbdulrahmanAljebreendeclares that he has no conflict of interest or financial disclosure. Majid Almadideclares that he has no conflict of interest or financial disclosure. Edward V Loftus, Jr declares that he has no conflict of interest or financial disclosure.

Ethical approval

This study was conducted in accordance with the protocol and principles of the Declaration of Helsinki. The study was approved by the Ethical Committee of the Institute for IBD Database registry with IRB project No. E-11-538.

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Informed consent was obtained from all individual participants included in the study.

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Azzam, N., AlRuthia, Y., Alharbi, O. et al. Factors associated with major radiological progression of primary sclerosing cholangitis in patients with inflammatory bowel disease. Hepatol Int 14, 1114–1124 (2020). https://doi.org/10.1007/s12072-020-10110-5

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