Älgå Lina Lindström, Ekheden Isabella, Thuresson Marcus, Ludvigsson Jonas F
Department of Medicine Huddinge MedH, Karolinska Institutet, Stockholm, Sweden.
Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Eur J Epidemiol. 2025 Aug 23. doi: 10.1007/s10654-025-01293-y.
The pathogenesis of primary sclerosing cholangitis (PSC), a severe autoimmune liver disease, remains largely unknown. Infection with Helicobacter pylori (H. pylori) and subsequent gastritis could act as a triggering event of PSC, as H. pylori seems to be more prevalent in chronic liver disease. However, the risk of PSC among patients with gastritis and its precursor, H. pylori infection, is undetermined. In this nationwide cohort study, we included Swedish individuals undergoing a gastroscopy with biopsy during 1990-2017 showing gastritis (n = 306 588) or H. pylori (n = 11 890). Three control groups were used (1) matched controls from the Swedish general population (n = 1 544 667), (2) individuals with a gastric biopsy indicating normal mucosa (n = 318 754) and (3) sibling controls (n = 231 879). We calculated the hazard ratios (HRs) for PSC development, adjusting for age, sex, calendar year, county, comorbidities, alcohol-related disorders, education, and country of birth. Patients with a histological diagnosis of gastritis or H. pylori were more likely to be diagnosed with PSC during follow up. Compared to the general Swedish population, the fully adjusted HR for PSC among patients with gastritis was 3.35 (95% CI 2.67-4.20). However, compared to secondary controls with a normal gastric mucosa, the PSC risk was not increased among patients with gastritis. Patients with a gastroscopy biopsy showing gastritis have a moderately increased risk for PSC later in life but not compared to other individuals undergoing gastrointestinal work up ("normal mucosa)". The association with PSC may be non-specific and apply to several gastrointestinal disorders.
原发性硬化性胆管炎（PSC）是一种严重的自身免疫性肝病，其发病机制在很大程度上仍不清楚。幽门螺杆菌（H. pylori）感染及随后的胃炎可能是PSC的触发事件，因为幽门螺杆菌似乎在慢性肝病中更为普遍。然而，胃炎患者及其前驱疾病幽门螺杆菌感染患者发生PSC的风险尚未确定。在这项全国性队列研究中，我们纳入了1990年至2017年间接受胃镜检查并活检显示胃炎（n = 306588）或幽门螺杆菌感染（n = 11890）的瑞典人。使用了三个对照组：（1）来自瑞典普通人群的匹配对照组（n = 1544667），（2）胃活检显示黏膜正常的个体（n = 318754），以及（3）同胞对照组（n = 231879）。我们计算了PSC发生的风险比（HRs），并对年龄、性别、日历年、县、合并症、酒精相关疾病、教育程度和出生国家进行了调整。组织学诊断为胃炎或幽门螺杆菌感染的患者在随访期间更有可能被诊断为PSC。与瑞典普通人群相比，胃炎患者中PSC的完全调整后HR为3.35（95%CI 2.67 - 4.20）。然而，与胃黏膜正常的二级对照组相比，胃炎患者的PSC风险并未增加。胃镜活检显示胃炎的患者在晚年发生PSC的风险适度增加，但与接受胃肠道检查的其他个体（“正常黏膜”）相比并非如此。与PSC的关联可能是非特异性的，适用于几种胃肠道疾病。
