Unique Phenotypic Characteristics and Clinical Course in Patients with Ulcerative Colitis and Primary Sclerosing Cholangitis: A Multicenter US Experience

Ming Hsi Wang, Omar Y. Mousa, Jessica J. Friton, Laura E. Raffals, Jonathan A. Leighton, Shabana F. Pasha, Michael F. Picco, Kelly C. Cushing, Kelly Monroe, Billy D. Nix, Rodney D. Newberry, William A. Faubion

Research output: Contribution to journalArticle

Abstract

Introduction: Ulcerative colitis (UC) associated with primary sclerosing cholangitis (PSC) is a rare phenotype. We aimed to assess patients with UC-PSC or UC alone and describe differences in clinical and phenotypic characteristics, antitumor necrosis factor (TNF) therapy, and long-term clinical outcomes. Methods: This retrospective multicenter cohort study included patients who received a diagnosis of UC from 1962 through 2015. We evaluated clinical factors associated with UC-PSC vs UC alone and assessed associations by using multivariable logistic regression models. Results: Among 522 patients with UC, 56 (10.7%) had PSC. Compared with UC alone, patients with UC-PSC were younger (younger than 20 years) at diagnosis (odds ratios [OR], 2.35; adjusted P = 0.02) and had milder UC severity (adjusted P = 0.05), despite having pancolonic involvement (OR, 7.01; adjusted P < 0.001). In the biologics era (calendar year 2005 to 2015), patients with UC-PSC less commonly received anti-TNF therapy compared with patients with UC (OR, 0.38; adjusted P = 0.009), but their response rates were similar. Fewer patients with UC-PSC received corticosteroids (OR, 0.24; adjusted P = 0.005) or rectal 5-aminosalicyte acid (OR, 0.26; adjusted P < 0.001). Other differences were identified that were not statistically significant in a multivariable model: patients with UC-PSC more commonly were male, had lower rates of smoking, and had higher rates of colorectal cancer and colectomy. Discussion: This study identified a unique phenotype of UC with concurrent PSC, which had different clinical behavior compared with UC only. These phenotypic characteristics can help identify high-risk patients with UC before PSC is diagnosed and guide different management and monitoring strategies.

Original languageEnglish (US)
Pages (from-to)774-779
Number of pages6
JournalInflammatory bowel diseases
Volume26
Issue number5
DOIs
StatePublished - Apr 11 2020

Keywords

  • cholangitis
  • colitis
  • sclerosing
  • ulcerative tumur necrosis factor-α antagonists

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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