Natural History of Ulcerative Colitis in Patients With Concomitant Primary Sclerosing Cholangitis

Abstract

Introduction: The natural history of Ulcerative Colitis (UC) in patients with concomitant primary sclerosing cholangitis (PSC) is poorly defined. We aimed to examine whether concurrent PSC and UC status was associated with increased risk of colectomy and requirement for multiple courses of corticosteroids (CS). Methods: We conducted a retrospective study among a cohort of nation-wide VA patients with UC. We first performed univariate comparison between UC patients with and without PSC. We then conducted two case-control analyses to determine the association between PSC status and outcomes related to UC disease course: colectomy for UC disease and receipt of two or more courses of CS after UC diagnosis. The exposure was presence or absence of PSC. Multivariable logistic regression analysis was conducted to estimate odds ratios (OR) and associated 95% confidence intervals (CIs) in each case-control analysis. We examined the following covariates in the multivariable model: duration of follow-up after UC diagnosis, sex, age at UC diagnosis, race, severity of UC, and extent of UC. Results: The analysis included 836 UC patients without PSC and 103 UC patients with PSC. In univariate comparisons, the PSC patients were more likely to have more extensive UC than those without PSC. However, the PSC patients were slightly less likely to have severe UC than non-PSC patients. The PSC patients were younger at diagnosis of UC and had longer period of follow-up after UC diagnosis. In multivaribale logistic regression analysis adjusting for duration of follow-up after UC diagnosis, sex, age at UC diagnosis, race, severity of UC, and extent of UC, PSC status was not associated with the risk of colectomy for UC (AOR 1.18, 95% CI: 0.49-2.84). Furthermore, PSC was not associated with a significantly increased risk of receiving two or more courses of steroids after adjusting for duration of follow-up after UC diagnosis, sex, age at UC diagnosis, race, severity of UC, and extent of UC (AOR 1.37, 95% CI: 0.85-2.22). However, without adjusting for UC extent and severity, PSC was associated with a modestly increased risk for the need for two or more courses of CS (AOR 1.58, 95% CI: 1.01-2.49); without adjusting for disease extent, the AOR was 1.72, 95% CI: 1.09-2.74.Table: Table. Comparison of PSC and non-PSC UC patientsConclusion: UC patients with PSC do not have a more benign disease course than UC patients without PSC. UC patients with PSC may have a modestly increased risk for multiple courses of steroids, and the risk increase appears to be mediated by more extensive UC involvement.