title: The clinical impact of primary sclerosing cholangitis in patients with an ileal pouch-anal anastomosis for ulcerative colitis.
abstract: BACKGROUND
  Primary sclerosing cholangitis (PSC), a chronic inflammatory disease affecting the liver, is associated with ulcerative colitis (UC) in up to 75% of Northern European patients. These patients are at increased risk for the development of colorectal cancer, and the operation of choice is restorative proctocolectomy with an ileal pouch-anal anastomosis. However, complications such as pouchitis can occur, and studies have suggested that PSC is an independent risk factor for the development of pouchitis.
  
  
  OBJECTIVE
  The aim of this study is to review and discuss the available literature on the effect of PSC on clinical outcomes of patients who undergo pouch surgery for UC. The outcomes reviewed comprise the incidence of pouchitis and pouch dysplasia/cancer and quality of life, including sexual function in UC patients with or without PSC.
  
  
  METHODS
  Pubmed/Medline and Embase searches were undertaken to obtain papers in English between 1966 and 2008. The keywords used were primary sclerosing cholangitis, ulcerative colitis, ileal pouch-anal anastomosis, quality of life, sexual function, dysplasia or cancer, pouchitis and orthotopic liver transplantation.
  
  
  RESULTS
  The incidence of pouchitis, pouch mucosal atrophy and risk of dysplasia appear to be greater in patients with associated PSC than in UC patients without PSC. Quality of life does not appear to be worse than in patients without PSC. Sexual function has not been studied in this subgroup of patients.
  
  
  CONCLUSIONS
  Pouchitis appears to be more common in the subset of UC patients with PSC, although there is clearly a need for further well-designed studies.
authors.affiliation: Department of Gastroenterology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. monira7@gmail.com
authors.forename: Monira
authors.initials: M
authors.lastname: Rahman
authors.forename: Paul
authors.initials: P
authors.lastname: Desmond
authors.forename: Neil
authors.initials: N
authors.lastname: Mortensen
authors.forename: Roger W
authors.initials: RW
authors.lastname: Chapman
mesh_terms: D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000601:surgery; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects / Q000473:pathology*; D006801:Humans; D016031:Liver Transplantation; D019449:Pouchitis / Q000209:etiology; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome