Prognostic value of perinuclear antineutrophil cytoplasmic antibodies in subjects with primary sclerosing cholangitis.

BACKGROUND

The aim of this study was to evaluate the prognostic value of perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) in subjects with primary sclerosing cholangitis (PSC) and in particular whether it is associated with inflammatory bowel disease (IBD).

METHODS

In the last 9 years, 64 patients were admitted to our Hospital with PSC: 34 males, mean age 53 years, range 17-90. All the patients had a cholestatic pattern of elevated serum enzymes. The diagnosis was made in most cases with magnetic resonance and in small percentages with endoscopic retrograde cholangiopancreatography (ERCP) or liver biopsy. In 33 patients with PSC, colonoscopy and p-ANCA assays were possible.

RESULTS

Thirteen patients showed p-ANCA positivity: 8 had ulcerative colitis (UC), with associated colon cancer (CC) in 3 cases, 3 had Crohn's disease (CD), 2 had no inflammatory bowel disease (IBD). Twenty patients were p-ANCA negative: only 1 with indeterminate IBD, while 19 had no IBD.

CONCLUSIONS

IBD, or especially UC, is present in85% of patients with CSP and p-ANCA positivity, whereas 95% of patients with PSC who test negative for p-ANCA do not have IBD.