How prevalent is primary sclerosing cholangitis (PSC) in patients living with IBD for more than 20 years?
Value in intermittent monitoring of PSC in patients with long-term IBD?
Lunder AK, Hov JR, Borthne A, et al. Prevalence of Sclerosing Cholangitis Detected by Magnetic Resonance Cholangiography in Patients With Long-term Inflammatory Bowel Disease. Gastroenterology. 2016 Oct;151(4):660–69. https://www.ncbi.nlm.nih.gov/pubmed/27342213
All patients newly diagnosed with IBD in south eastern Norway were enrolled into the cohort from 1990 to 1993. Magnetic resonance cholangiography (MRC) was performed after a 20-year follow-up; any prior MRCs were collected for retrospective review. MRCs were performed at 5 centres using 1.5 T scanners according to an MRI protocol. Images were independently reviewed by two experienced radiologists blinded to the patients’ medial histories. The presence of PSC lesions on MRC images was scored by consensus of two radiologists. Patients with positive MRCs at 20 years were re-assessed within 3 to 4 years.
Of the 756 patients with IBD, prevalence of PSC at baseline was 2.2%. The 322 patients who completed the follow-up (CD 100; UC 222) had similar clinical and demographic characteristics at baseline and were similar to the 148 patients who completed follow-up but did not undergo MRC. Inter-observer agreement was moderate for PSC-like lesions while the diagnostic sensitivity was 90.9% (measured using prior MRCs). During follow-up, an additional 19 patients developed PSC (total n=26 or 8.1%). All had intrahepatic involvement and most had isolated intrahepatic involvement. Extrahepatic bile duct structures were less common and only 1 person had isolated extrahepatic bile duct involvement. PSC lesions were more common in CD than UC (9.0% vs. 6.8%), and more common in women than men (9.2% vs. 5.9%). Compared to non-PSC patients, those with PSC self-reported more frequent chronic, continuous symptoms (P=0.012) and were prescribed more steroids in the first 5 years of IBD (P=0.018). Colectomy-rate was higher in the PSC group (3 vs. 1 patient) for cancer or dysplasia of the colon (P=0.016). Among the 24 subclinical PSC patients who were re-examined after a median of 3.2 years, all exhibited signs of disease progression.
Study Design: Population-based cohort study – IBSEN Study
Funding: South-East Norway Regional Health Authority, Akershus University Hospital Research Foundation, Norwegian PSC Research Center, and Norwegian Society of Radiology
Setting: South eastern Norway
Level of Evidence: 2b (Oxford Levels of Evidence)
The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.