Norwegian PSC Research Center, Clinic for Specialized Medicine and Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Inflamm Bowel Dis. 2012 Mar;18(3):536-45. doi: 10.1002/ibd.21699. Epub 2011 Mar 31.
Inflammatory bowel disease (IBD) in patients with primary sclerosing cholangitis (PSC) seems to differ from IBD without PSC, but a systematic, prospective study of IBD in PSC has until now not been reported. We aimed to describe the clinical, endoscopic, and histopathologic features of PSC-IBD in liver-transplanted and nontransplanted patients.
PSC patients (n = 184) were included and underwent ileocolonoscopy with assessment of segmental histopathology.
A total of 155 (84%) patients had IBD, of whom 39 (25%) had undergone colectomy. The patients with an intact colon and complete tissue samples (n = 110) were further investigated. Forty-two (38%) patients had undergone liver transplantation. The median IBD duration was 11 (range, 0-50) years. The majority (65%) had no or sparse IBD symptoms. Inflammatory findings were more frequent by histology than by endoscopy (89% versus 47%, P < 0.001). Histopathological signs of inflammation involved the right colon in 86% of patients and were purely right-sided in 23%. The findings of inflammation were higher in the right compared to the left colon (P < 0.001), but the general inflammatory activity was low. Backwash ileitis was demonstrated in 20% (17/87) of patients and rectal sparing in 65% (70/107). The liver-transplanted patients had lower clinical (P = 0.035) and histological (P = 0.013) IBD activity than the nontransplanted group.
PSC-IBD may represent a distinct entity of colitis in which low endoscopic activity may mask an active histologic inflammation that possibly contributes to an increased risk of malignancy. Circumstances related to liver transplantation seem to act favorably on colonic inflammation in PSC.
原发性硬化性胆管炎（PSC）患者的炎症性肠病（IBD）似乎与无 PSC 的 IBD 不同，但目前尚未有关于 PSC 中 IBD 的系统、前瞻性研究报告。我们旨在描述肝移植和未肝移植的 PSC-IBD 患者的临床、内镜和组织病理学特征。
纳入了 184 例 PSC 患者，并进行了回结肠镜检查和节段性组织病理学评估。
共有 155 例（84%）患者患有 IBD，其中 39 例（25%）患者接受了结肠切除术。进一步调查了 110 例结肠完整且组织样本完整的患者。42 例（38%）患者接受了肝移植。IBD 病程的中位数为 11 年（范围，0-50 年）。大多数（65%）患者没有或仅有稀疏的 IBD 症状。组织学上的炎症表现比内镜下更为常见（89%对 47%，P < 0.001）。炎症的组织病理学表现累及右半结肠的患者占 86%，单纯累及右半结肠的患者占 23%。右半结肠的炎症表现高于左半结肠（P < 0.001），但总体炎症活动度较低。20%（17/87）的患者存在回肠反流性炎症，65%（70/107）的患者存在直肠保留。与未肝移植组相比，肝移植组的患者临床（P = 0.035）和组织学（P = 0.013）IBD 活动度较低。
PSC-IBD 可能代表一种独特的结肠炎实体，其低内镜活动可能掩盖了活跃的组织学炎症，这可能增加了恶性肿瘤的风险。与肝移植相关的情况似乎对 PSC 中的结肠炎症产生有利影响。
