Coexisting inflammatory bowel disease in primary sclerosing cholangitis is associated with higher colorectal cancer and transplant risk.

BACKGROUND

Primary sclerosing cholangitis (PSC) is often intertwined with inflammatory bowel disease (IBD), presenting a complex clinical scenario. The coexistence of IBD-PSC complicates disease management and progression, potentially exacerbating outcomes.

OBJECTIVES

This study aims to evaluate the specific impact of IBD in patients with PSC, focusing on both liver-related and IBD-specific clinical outcomes.

METHODS

This retrospective study, utilizing the TriNetX database, performed propensity score matching to compare clinical outcomes between IBD-PSC and PSC-only patients, as well as IBD-PSC and IBD-only patients. Diagnoses were identified based on International Classification of Diseases-10 coding.

RESULTS

The study analyzed 1941 patients with IBD-PSC, 234,081 with IBD alone, and 628 with PSC alone. Patients with IBD-PSC had significantly higher mortality compared to IBD alone (16.0% vs. 7.5%; hazard ratio [HR]: 2.256, 95% confidence interval [CI]: 1.853-2.747, p < 0.001), as well as increased rates of hospitalization (32.8% vs. 14.5%; HR: 2.641, 95% CI: 2.213-3.152, p < 0.001) and intensive care unit admission (18.7% vs. 5.8%; HR: 3.691, 95% CI: 2.954-4.612, p < 0.001). Colorectal cancer was also more frequent in the IBD-PSC group (2.4% vs. 0.7%; HR: 3.370, 95% CI: 1.846-6.152, p < 0.001). When compared to PSC alone, IBD-PSC patients had a higher rate of liver transplantation (12.3% vs. 8.0%; HR: 1.492, 95% CI: 1.012-2.198, p = 0.042), whereas rates of hepatocellular carcinoma and cholangiocarcinoma were similar between groups.

CONCLUSIONS

Patients with coexisting IBD and PSC experience greater clinical severity, including higher mortality, hospitalization, and colorectal cancer risk. They also have increased liver transplant incidence. Further research is needed to explore underlying mechanisms and improve management.