The impact of ursodeoxycholic acid on cancer, dysplasia and mortality in ulcerative colitis patients with primary sclerosing cholangitis.
BACKGROUND
Colorectal cancer in primary sclerosing cholangitis patients with ulcerative colitis is mostly right-sided where concentrations of carcinogenic secondary bile acids are highest.


OBJECTIVE
To investigate whether ursodeoxycholic acid could be chemopreventive for colorectal cancer.


METHODS
A historical cohort study was performed on primary sclerosing cholangitis patients with ulcerative colitis where the 28 patients (cases) who were treated with ursodeoxycholic acid for at least 6 months (mean 3.4 +/- 2.7 years) were compared with the 92 patients (controls) who were not treated with ursodeoxycholic acid. The primary outcomes were colorectal cancer and dysplasia. The secondary outcome was overall mortality.


RESULTS
The cumulative incidence of dysplasia or cancer was not significantly different between cases and controls (P = 0.17 by log-rank test). The adjusted relative risk for cases of developing dysplasia or cancer was 0.59 (95% CI 0.26-1.36). The cumulative mortality was significantly different between groups (P = 0.02 by log-rank test). The adjusted relative risk for cases of death was 0.44 (95% CI 0.22-0.90).


CONCLUSIONS
In ulcerative colitis patients with primary sclerosing cholangitis, ursodeoxycholic acid did not reduce the risk of developing cancer or dysplasia. However, ursodeoxycholic acid may reduce mortality.
Wolf
J M
JM
Department of Gastroenterology, Center for Inflammatory Bowel Disease, Cleveland, OH 44195, USA.
Rybicki
L A
LA
Lashner
B A
BA
D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D003106:Colon / Q000473:pathology; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D012007:Rectum / Q000473:pathology; D012307:Risk Factors; D012737:Sex Factors; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid