The impact of ulcerative colitis on the long-term outcome of patients with primary sclerosing cholangitis

Aliment Pharmacol Ther. 2012 May;35(9):1045-53. doi: 10.1111/j.1365-2036.2012.05063.x. Epub 2012 Mar 19.


Background: The impact of ulcerative colitis (UC) on the outcome of primary sclerosing cholangitis (PSC) outcome remains unclear.

Aim: To investigate whether the presence of UC is associated with a worse clinical of associated PSC.

Methods: A total of 222 patients with PSC (167 with UC and 55 without UC) seen and followed at a single centre from 1985 to 2011 were included. Clinical and demographic variables were obtained and patients were followed until the date of their last clinic visit.

Results: The median age at presentation of PSC with associated UC was 38 vs. 47 years without UC (P < 0.001). At presentation, median serum bilirubin (2.1 vs. 4.5, P < 0.001) and the Mayo PSC Risk Score (0.95 vs. 1.69, P < 0.001) were lower in those with UC vs. those without UC. A total of 55 of 167 (32.9%) patients with PSC-UC developed colon neoplasia in contrast to 1 of the 55 (1.8%) patients with PSC. (P < 0.001) On proportional hazards analysis, UC (hazard ratio (HR) = 0.90 [95% confidence interval (CI): 0.60-1.34, P = 0.60] was not associated with death or orthotopic liver transplantation (OLT), when adjusting for gender, Mayo risk score and year of PSC diagnosis; whereas the revised Mayo risk score [HR = 5.08, 95% CI: (2.62-9.86), P < 0.001] was associated with a greater risk of OLT or death.

Conclusions: Primary sclerosing cholangitis often is recognised at an early stage in patients with concurrent ulcerative colitis; ulcerative colitis has no impact on long-term prognosis in terms of liver-related outcomes when adjusted for the severity of liver disease.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Cholangitis, Sclerosing / physiopathology*
  • Cholangitis, Sclerosing / surgery
  • Cohort Studies
  • Colitis, Ulcerative / complications*
  • Confidence Intervals
  • Female
  • Follow-Up Studies
  • Humans
  • Liver Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk
  • Severity of Illness Index
  • Young Adult