Secondary sclerosing cholangitis: a comparison to primary sclerosing cholangitis.
OBJECTIVE
The natural history of secondary sclerosing cholangitis (SSC) is ill-defined. In order to better determine the natural history of this condition, we retrospectively reviewed data from the Mayo Clinic in Rochester, Minnesota. We also compared the natural history of patients diagnosed with SSC to a cohort with a diagnosis of primary sclerosing cholangitis (PSC).


METHODS
We used a computer-assisted search to identify patients with a diagnosis of SSC seen from 1992 to 2002. The diagnosis was confirmed by chart review and information about age, gender, etiology, therapy, and clinical course was sought. We excluded those presumed SSC patients who had a history of inflammatory bowel disease, those with malignancy at the time of diagnosis, and those who had undergone liver transplantation prior to the diagnosis of SSC. Patients with PSC matched for age, gender, and serum bilirubin level served as disease controls.


RESULTS
We identified 31 patients, average age 57, (range 28-79). The causes of SSC included surgical trauma from cholecystectomy (13 patients), intraductal stones (12 patients), recurrent pancreatitis (4 patients), and abdominal injury (2 patients). Nine patients with SSC ultimately required liver transplantation and 4 patients have died. When compared to matched patients with PSC, the survival free of transplant was significantly shortened (p<0.03).


CONCLUSIONS
When the long-term outcome of SSC patients was compared to matched PSC controls, the SSC patients had a poorer outcome. The natural history of SSC is characterized by a shortened life expectancy.
Gossard
Andrea A
AA
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Angulo
Paul
P
Lindor
Keith D
KD
D000007:Abdominal Injuries / Q000150:complications; D000328:Adult; D000368:Aged; D001706:Biopsy; D015209:Cholangitis, Sclerosing / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects; D042883:Choledocholithiasis / Q000150:complications; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies