Intest Res.  2023 Oct;21(4):452-459. 10.5217/ir.2022.00087.

Low prevalence of primary sclerosing cholangitis in patients with inflammatory bowel disease in India

• Singh A
• Midha V
• Narang V
• Kedia S
• Mahajan R
• Dhoble P
• Kahlon BK
• Dhaliwal AS
• Tripathi A
• Kalra S
• Jain NP
• Bansal N
• Banerjee R
• Desai D
• Dutta U
• Ahuja V
• Sood A

• KMID: 2547195
• DOI: http://doi.org/10.5217/ir.2022.00087

Abstract

Background/Aims
Primary sclerosing cholangitis (PSC) represents the most common hepatobiliary extraintestinal manifestation of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Limited data exist on PSC in patients with IBD from India. We aimed to assess the prevalence and disease spectrum of PSC in Indian patients with IBD.
Methods
Database of IBD patients at 5 tertiary care IBD centers in India were analyzed retrospectively. Data were extracted and the prevalence of PSC-IBD was calculated.
Results
Forty-eight patients out of 12,216 patients with IBD (9,231 UC, 2,939 CD, and 46 IBD unclassified) were identified to have PSC, resulting in a prevalence of 0.39%. The UC to CD ratio was 7:1. Male sex and pancolitis (UC) or colonic CD were more commonly associated with PSC-IBD. The diagnosis of IBD preceded the diagnosis of PSC in most of the patients. Majority of the patients were symptomatic for liver disease at diagnosis. Eight patients (16.66%) developed cirrhosis, 5 patients (10.41%), all UC, developed malignancies (3 colorectal cancer [6.25%] and 2 cholangiocarcinoma [4.16%]), and 3 patients died (2 decompensated liver disease [4.16%] and 1 cholangiocarcinoma [2.08%]) on follow-up. None of the patients mandated surgical therapy for IBD.
Conclusions
Concomitant PSC in patients with IBD is uncommon in India and is associated with lower rates of development of malignancies.

Keyword

Colitis, ulcerative; Cholangitis, sclerosing; Prevalence; Inflammatory bowel diseases; India

Figure

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  Fig. 1. PSC in patients with IBD. (A) Prevalence and distribution of PSC in patients with IBD. (B) The prevalence of PSC in patients with UC and CD. PSC, primary sclerosing cholangitis; IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease.

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  Fig. 2. Prevalence of malignancies in patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD).

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