title: Severity of primary sclerosing cholangitis and its impact on the clinical outcome of Crohn's disease.
abstract: OBJECTIVE
  Crohn's disease (CD) is associated with primary sclerosing cholangitis (PSC). The aim of the study was to study the association between the severity of PSC and clinical outcome of CD, comparing the course of CD in patients with PSC not needing orthotopic liver transplantation (OLT) and those requiring OLT.
  
  
  METHODS
  A total of 41 patients with PSC and CD seen at the Cleveland Clinic between 1985 and 2011 were included in this study. Clinical and demographic variables were obtained regarding the outcome of CD in patients with and without OLT.
  
  
  RESULTS
  Patients with PSC-CD were divided into two groups: 20 without OLT (non-OLT) and 21 with OLT. 18 (85.7%) of patients in the OLT group had pancolitis in contrast to 14 (70%) in the non-OLT group. (p=0.22). There were no significant differences regarding duration of CD, but the duration of PSC was longer in the OLT group [16.0±7.8 vs. 10.3±6.4, p=0.01]. The OLT and non-OLT groups did not differ in the number of CD flares [0 (0, 0) vs. 0 (0, 5), p=0.28) and need for surgery for CD [(6 (28.6%) vs. 9 (45%), p=0.27]. Colon carcinoma and dysplasia were similar in the non-OLT and OLT groups [(4 (20%) vs. 3 (13.2%), p=0.52]. On Cox regression analysis, OLT for PSC [Hazards ratio (HR) 1.2 (95% confidence interval (C.I.): 0.38-3.7, p=0.79] did not impact the risk of colectomy.
  
  
  CONCLUSIONS
  In contrast to UC, severe PSC requiring OLT does not appear to impact the clinical outcome of CD.
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA. navaneu@ccf.org
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Preethi
authors.initials: P
authors.lastname: G K Venkatesh
authors.forename: Bret A
authors.initials: BA
authors.lastname: Lashner
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000368:Aged; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000601:surgery; D015331:Cohort Studies; D003082:Colectomy / Q000706:statistics & numerical data; D003092:Colitis / Q000150:complications / Q000473:pathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index