title: Increased risk of colorectal cancer and dysplasia in patients with Crohn's colitis and primary sclerosing cholangitis.
abstract: BACKGROUND
  Almost 10% of all patients with primary sclerosing cholangitis receive a diagnosis of Crohn's disease. Clinical characteristics and the risk of colon cancer or dysplasia in Crohn's disease and primary sclerosing cholangitis are less well examined than in ulcerative colitis.
  
  
  OBJECTIVE
  This study aimed to describe the clinical characteristics and risk of colorectal dysplasia and cancer in Crohn's disease in patients with primary sclerosing cholangitis.
  
  
  METHODS
  This is a cohort study of all patients diagnosed with primary sclerosing cholangitis and colorectal Crohn's disease at Karolinska University Hospital, Huddinge, 1978 to 2006. Each patient was matched for age and the onset of Crohn's disease to 2 controls with colorectal Crohn's disease without liver disease.
  
  
  METHODS
  This study was conducted at a tertiary referral center.
  
  
  METHODS
  Twenty-eight patients (61% male) with primary sclerosing cholangitis and Crohn's disease and 46 patients (50% male) with Crohn's disease alone were studied. Clinical and endoscopic data were retrieved from medical records. Colonic biopsies from patients with primary sclerosing cholangitis were re-reviewed.
  
  
  METHODS
  The primary outcome measured was the proportion of patients developing colorectal cancer.
  
  
  RESULTS
  Colorectal cancer or dysplasia developed in 9 patients with primary sclerosing cholangitis and in 3 controls. Patients with primary sclerosing cholangitis were more likely to develop colorectal dysplasia or cancer than controls (OR 6.78; 95% CI (1.65-27.9); P = .016). In patients with primary sclerosing cholangitis compared with controls, perianal fistulas occurred in 3% vs 33% (P = .003), bowel strictures occurred in 7% vs 30% (P = .03), and bowel surgery was performed in 18% vs 46% (P = .01). Histological granulomas were seen in 29% of the patients with primary sclerosing cholangitis compared with 43% in controls (P = not significant).
  
  
  CONCLUSIONS
  This study was limited by its retrospective nature and the limited cohort.
  
  
  CONCLUSIONS
  Primary sclerosing cholangitis is a risk factor for the development of colorectal cancer and dysplasia in Crohn's disease. Obstructing disease and perianal fistulas are rare in primary sclerosing cholangitis and less common than in colonic Crohn's disease without liver disease.
authors: Division of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. lina.lindstrom@karolinska.se
authors: Lina
authors: L
authors: Lindström
authors: Annika
authors: A
authors: Lapidus
authors: Ake
authors: A
authors: Ost
authors: Annika
authors: A
authors: Bergquist
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D003092:Colitis / Q000150:complications / Q000401:mortality / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D003424:Crohn Disease / Q000150:complications / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000150:complications / Q000401:mortality / Q000473:pathology*; D055815:Young Adult