Letter: impact of concomitant autoimmune diseases on the outcome of primary sclerosing cholangitis.

Abstract

We read with interest the recently published article: ‘patients with large-duct primary sclerosing cholangitis (PSC) and Crohn's disease have a better outcome than those with ulcerative colitis, or without inflammatory bowel disease (IBD)’ by Fevery et al.1 The main finding of the study is that the liver disease of large-duct PSC patients with Crohn's disease is less progressive than in those without IBD. Based on this, the authors discussed whether Crohn's disease could exert a protective effect on the liver. It is known that IBD was associated with poor outcomes of patients with PSC.2 However, in the report by Yanai et al.,3 patients with PSC were compared with those with coexisting IBD to identify predictors of outcome. The authors found survival rate of PSC patients is independent of coexisting IBD. In recent paper by Jegadeesan et al.,4 a total of 287 PSC patients’ records were retrospectively evaluated. The authors did not find any significant difference in the median time to liver transplantation since the diagnosis of PSC between PSC patients with and without non-IBD immunological diseases. In the subgroup analysis, there was also no significant difference in the median time to liver transplantation since the diagnosis of PSC between the PSC group, PSC with non-IBD immunological diseases group, and PSC with IBD group. These results suggest that the increased load of immunological diseases, including the presence of non-IBD immunological diseases or IBD, have minimum impact on the disease outcome of PSC. Therefore, concomitant autoimmune diseases appear to have little impact on long-term prognosis for liver-related outcomes of PSC patients. Given the population-specific features and other yet unknown factors, further large studies are necessary to evaluate the role of concurrent immunological diseases in patients with PSC. Declaration of personal and funding interests: None.