Clinical and Prognostic Factors Associated With Inflammatory Bowel Disease in a Highly Admixed Population With Primary Sclerosing Cholangitis.
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Nardelli Mateus Jorge, Cançado Guilherme Grossi Lopes, Barros Luísa Leite, Dotta Diogo Delgado, Faria Luciana Costa, Rotman Vivian, Villela-Nogueira Cristiane Alves, Ferraz Maria Lucia Gomes, Rocco Rodrigo, Felga Guilherme Eduardo, Martins Adrielly de Souza, Codes Liana, Mendes Liliana Sampaio Costa, Silva Marlone Cunha da, Hyppolito Elodie Bonfim, Gomide Geisa Perez Medina, Signorelli Izabelle Venturini, Oliveira Maria Beatriz de, Ivantes Claudia Alexandra Pontes, Chiara Maria, Borges Valéria Ferreira de Almeida E, Terrabuio Débora Raquel Benedita, Cançado Eduardo Luiz Rachid, Bittencourt Paulo Lisboa, Couto Claudia Alves
Аннотация
BACKGROUND: IBD is reported worldwide in 62% to 81% of patients with PSC, especially in males and north Europeans. Little is known about the association of IBD and PSC in population from multigenetic ethnic origin.
STUDY: Data of PSC patients from the Brazilian Cholestasis Study Group database were retrospectively reviewed to compare demographic, clinical, laboratory, and transplant-free survival between those with and without IBD.
RESULTS: After exclusion of 59 (14%) participants with overlap syndrome with autoimmune hepatitis, 359 individuals with PSC were included {56% male, median age 44 [interquartile range (IQR): 33 to 54] y}. IBD was investigated in 298 (83%) participants and diagnosed in 217 (73%), including ulcerative colitis (83%), Crohn's disease (13%), and indeterminate colitis (4%). Male sex frequency was similar in patients with and without IBD (58% vs. 47%, P =0.073). IBD was more frequently diagnosed in patients without obesity ( P =0.035), positive for antinuclear antibody ( P =0.006), and positive for anti-smooth muscle antibody ( P =0.046). IBD diagnosis occurred before, concomitant, or after PSC diagnosis in 59%, 22%, and 19% of cases, respectively. IBD was more frequently diagnosed before PSC in participants asymptomatic for liver disease ( P =0.017), without advanced liver disease ( P =0.017), before liver transplantation (LT) ( P <0.001), and positive for antinuclear antibody ( P =0.021). In a median follow-up of 69 months (IQR 31-124), LT occurred in 27.7% and cohort mortality was 11.4%. IBD was neither associated with the combined outcome of death or LT ( P =0.745) nor with transplant-free survival ( P =0.902).
CONCLUSIONS: In Brazilian PSC patients, IBD frequency was similar to that reported in other populations but exhibited a balanced proportion between males and females. IBD diagnosis occurred before PSC in most patients, especially those without advanced liver disease. IBD presence was not associated with worse PSC prognosis.