Progressive Primary Sclerosing Cholangitis Requiring Liver Transplantation Is Associated With Reduced Need for Colectomy in Patients With Ulcerative Colitis

被引:64
作者
Navaneethan, Udayakumar [1 ]
Venkatesh, Preethi G. K. [1 ]
Mukewar, Saurabh [1 ]
Lashner, Bret A. [1 ]
Remzi, Feza H. [2 ]
McCullough, Arthur J. [1 ]
Kiran, Ravi P. [2 ]
Shen, Bo [1 ]
Fung, John J. [3 ]
机构
[1] Cleveland Clin, Inst Digest Dis, Dept Gastroenterol, Cleveland, OH 44106 USA
[2] Cleveland Clin, Inst Digest Dis, Dept Colorectal Surg, Cleveland, OH 44106 USA
[3] Cleveland Clin, Inst Digest Dis, Dept Transplant Surg, Cleveland, OH 44106 USA
关键词
Inflammatory Bowel Disease; Risk Factors; Prognostic; Liver Disease; INFLAMMATORY-BOWEL-DISEASE; PSC-IBD; PREVALENCE; NEOPLASIA; SEVERITY;
D O I
10.1016/j.cgh.2012.01.006
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND & AIMS: We investigated the association between the severity of primary sclerosing cholangitis (PSC) and clinical outcomes of patients with ulcerative colitis (UC) on the basis of need for colectomy. METHODS: We analyzed data from 167 patients with PSC and UC who were followed from 1985 to 2011. Patients with PSC and UC were divided into groups that received orthotopic liver transplantation (OLT) (n = 86) or did not (non-OLT, n = 81). Clinical and demographic variables were obtained, and patients were followed until they received OLT or the date of their last clinical visit. RESULTS: The OLT group had significantly more subjects with less severe symptoms of UC (59, 68.6%) than the non-OLT group (12, 14.8%; P < .001). The subjects in the OLT group had a median of 0 UC flares compared with 3 in the non-OLT group (P < .001); fewer subjects in the OLT group required use of azathioprine or mercaptopurine (1, 1.2%), compared with the non-OLT group (14, 17.3%; P < .006). More subjects in the non-OLT group required colectomies (61, 75.3%) than in the OLT group (23, 26.7%; P < .001). On the basis of Cox regression analysis, OLT for PSC independently reduces the need for colectomy (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.25-0.75; P = .003), as does a high Mayo risk score at diagnosis (HR, 0.52; 95% CI, 0.37-0.72; P < .001). Development of colon neoplasia increased the risk for colectomy (HR, 2.47; 95% CI, 1.63-3.75; P < .001). CONCLUSIONS: Severe progressive PSC that requires liver transplantation appears to reduce the disease activity of UC and the need for colectomy.
引用
收藏
页码:540 / 546
页数:7
相关论文
共 20 条
[1]   The immunobiology of primary sclerosing cholangitis [J].
Aoki, CA ;
Bowlus, CL ;
Gershwin, ME .
AUTOIMMUNITY REVIEWS, 2005, 4 (03) :137-143
[2]   IN-VITRO AND IN-VIVO STUDIES OF CELLULAR IMMUNITY IN ALCOHOLIC CIRRHOSIS [J].
BERENYI, MR ;
STRAUS, B ;
CRUZ, D .
AMERICAN JOURNAL OF DIGESTIVE DISEASES, 1974, 19 (03) :199-205
[3]   SUBCLINICAL TIME SPAN OF INFLAMMATORY BOWEL-DISEASE IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS [J].
BROOME, U ;
LOFBERG, R ;
LUNDQVIST, K ;
VERESS, B .
DISEASES OF THE COLON & RECTUM, 1995, 38 (12) :1301-1305
[4]   Primary sclerosing cholangitis, inflammatory a bowel disease, and colon cancer [J].
Broome, Ulrika ;
Bergquist, Annika .
SEMINARS IN LIVER DISEASE, 2006, 26 (01) :31-41
[5]   Pediatric "PSC-IBD": A descriptive report of associated inflammatory bowel disease among pediatric patients with PSC [J].
Faubion, WA ;
Loftus, EV ;
Sandborn, WJ ;
Freese, DK ;
Perrault, J .
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 2001, 33 (03) :296-300
[6]   RELATIONSHIP OF INFLAMMATORY BOWEL-DISEASE AND PRIMARY SCLEROSING CHOLANGITIS [J].
FAUSA, O ;
SCHRUMPF, E ;
ELGJO, K .
SEMINARS IN LIVER DISEASE, 1991, 11 (01) :31-39
[7]   Backwash ileitis is strongly associated with colorectal carcinoma in ulcerative colitis [J].
Heuschen, UA ;
Hinz, U ;
Allemeyer, EH ;
Stern, J ;
Lucas, M ;
Autschbach, F ;
Herfarth, C ;
Heuschen, G .
GASTROENTEROLOGY, 2001, 120 (04) :841-847
[8]   Pathologic Features of Ulcerative Colitis in Patients With Primary Sclerosing Cholangitis A Case-control Study [J].
Joo, Mee ;
Abreu-e-Lima, Paula ;
Farraye, Francis ;
Smith, Timothy ;
Swaroop, Prabhakar ;
Gardner, Laura ;
Lauwers, Gregory Y. ;
Odze, Robert Daniel .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 2009, 33 (06) :854-862
[9]   The relative role of the Child-Pugh classification and the Mayo natural history model in the assessment of survival in patients with primary sclerosing cholangitis [J].
Kim, WR ;
Poterucha, JJ ;
Wiesner, RH ;
LaRusso, NF ;
Lindor, KD ;
Petz, J ;
Therneau, TM ;
Malinchoc, M ;
Dickson, ER .
HEPATOLOGY, 1999, 29 (06) :1643-1648
[10]   PSC-IBD: a unique form of inflammatory bowel disease associated with primary sclerosing cholangitis [J].
Loftus, EV ;
Harewood, GC ;
Loftus, CG ;
Tremaine, WJ ;
Harmsen, WS ;
Zinsmeister, AR ;
Jewell, DA ;
Sandborn, WJ .
GUT, 2005, 54 (01) :91-96