Patients with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) had distinct disease symptoms compared with patients with PSC or UC alone. These findings, from a retrospective study, were published in the World Journal of Gastroenterology.

Patients with UC (n=28), Crohn disease (CD; n=10), PSC without inflammatory bowel disease (IBD) (n=4), PSC-UC (n=26), and PSC-CD (n=6) had colonic biopsy and resection specimens collected between 1999 and 2013 at the Barnes-Jewish Hospital in the United States. Patients with and without PSC were matched for age and CD or UC disease duration.

Among patients with UC, the PSC-UC and UC groups did not differ significantly for sex, diagnosis age, or dysplasia rates. Fewer patients with PSC-UC were treated with steroids (31% vs 68%; P =.01) or had colectomies (38% vs 68%; P =.03) compared with patients with UC alone.

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The biopsy data indicated that in patients with PSC-UC, disease was more likely to be confined to the right side of the colon (29% vs 4%; P =.03), activity scores were lower in the rectum (P =.03 vs P =.0006), there was less basal plasmacytosis in the left colon and rectum (P =.01 vs P =.0004), and overall inflammation was lower across all sites (P =.0005), compared with UC alone, respectively.

Among patients with CD, the PSC-CD and CD groups were well balanced for age at diagnosis, CD disease duration, colectomy rates, and dysplasia rates. The PSC-CD group had more men (P =.03), and fewer were treated with anti-tumor necrosis factor (TNF) therapy (17% vs 78%; P =.04) compared with patients with CD alone. Comparison of biopsy specimens between patient groups did not reveal any significant differences.

Patients with PSC-UC and PSC-CD had similar biopsy results, except that patients with PSC-CD had higher disease activity scores in the terminal ileum (1.0 vs 0.31, respectively; P =.01) compared with patients with PSC-UC. Patients with PSC and no IBD had normal colonic biopsy specimens.

Patients with PSC-IBD who had an orthotopic liver transplantation (OLT) presented with more rectal involvement (P =.04), a more inflamed rectum (P =.04), and a more inflamed left colon (P =.04) compared with patients with PSC-IBD not requiring OLT.

This study was limited by its small sample size; however, due to the rarity of these diseases, collection of such specimens was inherently difficult.

The study authors concluded that patients with PSC-UC had a distinct disease phenotype compared with patients with either disease alone. Furthermore, patients with PSC-IBD who had a liver transplant presented with more severe IBD symptoms than patients with the same disease state not requiring a transplant.

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Aranake-Chrisinger J, Dassopoulos T, Yan Y, et al. Primary sclerosing cholangitis associated colitis: characterization of clinical, histologic features, and their associations with liver transplantation. World J Gastroenterol. 2020;26(28):4126-4139. doi: 10.3748/wjg.v26.i28.4126.