Screen for Primary Sclerosing Cholangitis in IBD?

By Reuters Staff

September 07, 2021

NEW YORK (Reuters Health) - About 2% of patients with inflammatory bowel diseases (IBD) will develop primary sclerosing cholangitis (PSC), with a higher prevalence in men than women, according to a new analysis.

In a paper in Gastroenterology, the researchers note that almost half of patients with IBD, including ulcerative colitis (UC) and Crohn's disease (CD), will develop extraintestinal manifestations during their lifetime, including PSC, which is characterized by inflammation and fibrosis of intrahepatic and extrahepatic bile ducts, eventually evolving to cirrhosis and cancer in most patients.

Although the association between IBD and PSC is "well recognized, uncertainties remain about the magnitude of this problem," Dr. Brigida Barberio of the University of Padova, in Italy, and colleagues point out.

To investigate, they did a systematic review and meta-analysis including 64 global studies with more than 776,000 patients in total.

They report a pooled prevalence of PSC in patients with IBD of 2.16%. The pooled prevalence of PSC in UC or CD separately was 2.47% and 0.96%, respectively. In IBD-unclassified (IBD-U), it was 5.01%.

Overall, the highest prevalence rates of PSC in IBD patients were observed in South America and the lowest in Southeast Asia.

The prevalence of PSC was generally higher in men, patients with more extensive rather than left-sided UC, or ileocolonic or colonic rather than ileal CD.

The data also suggest a higher prevalence of small-duct PSC in CD compared with UC (33.9% versus 19.7%, respectively).

"Our findings provide the first pooled estimates of the burden of PSC in IBD, as well as potential risk factors, which may be important in establishing a prompt diagnosis and initiating appropriate surveillance for relevant gastrointestinal malignancies," Dr. Barberio and colleagues conclude.

"Clinicians who care for patients with IBD must recognize and carefully screen for PSC, as an early appropriate diagnosis is imperative to prevent complications," they suggest.

SOURCE: Gastroenterology, online August 19, 2021.