Clinical characteristics of ulcerative colitis associated with primary sclerosing cholangitis in Korea.

BACKGROUND

Primary sclerosing cholangitis (PSC) is well known as one of the extraintestinal manifestations of ulcerative colitis (UC). However, the prevalence of PSC in UC patients together with the clinical characteristics and outcomes of UC associated with PSC (UC-PSC) are not clear in Asians.

METHODS

We retrospectively reviewed the medical records of UC patients who were registered and followed up at the Asan Medical Center. The prevalence of PSC in UC and the clinical features of UC-PSC compared with matched UC without PSC were investigated.

RESULTS

A total of 1849 patients diagnosed with UC between July 1977 and September 2009 were reviewed. Among these, 21 UC-PSC patients (1.1%) were identified. The cumulative probability of PSC after diagnosis of UC was 0.71% after 1-5 years, 1.42% after 10 years, 2.59% after 15 years, and 3.35% after 20-25 years. Compared with 63 matched UC alone patients, UC-PSC showed pancolitis (95.2%), rectal sparing (38.1%), and backwash ileitis (42.9%) more frequently (P < 0.001). During follow-up, three of 21 UC-PSC patients (14.3%) were diagnosed with colorectal neoplasia and three patients (14.3%) died of PSC-associated complications. UC-PSC patients were associated with increased probability of colorectal neoplasia development (P = 0.036) and a trend toward increased mortality compared with the UC alone group.

CONCLUSIONS

The prevalence of PSC in Korean UC patients appears to be lower than that of Western patients. Similar to Caucasians, UC-PSC shows unique colonoscopic features and is associated with more frequent colorectal neoplasia development and poor prognosis in Korea.