title: The impact of ulcerative colitis on the long-term outcome of patients with primary sclerosing cholangitis.
abstract: BACKGROUND
  The impact of ulcerative colitis (UC) on the outcome of primary sclerosing cholangitis (PSC) outcome remains unclear.
  
  
  OBJECTIVE
  To investigate whether the presence of UC is associated with a worse clinical of associated PSC.
  
  
  METHODS
  A total of 222 patients with PSC (167 with UC and 55 without UC) seen and followed at a single centre from 1985 to 2011 were included. Clinical and demographic variables were obtained and patients were followed until the date of their last clinic visit.
  
  
  RESULTS
  The median age at presentation of PSC with associated UC was 38 vs. 47 years without UC (P < 0.001). At presentation, median serum bilirubin (2.1 vs. 4.5, P < 0.001) and the Mayo PSC Risk Score (0.95 vs. 1.69, P < 0.001) were lower in those with UC vs. those without UC. A total of 55 of 167 (32.9%) patients with PSC-UC developed colon neoplasia in contrast to 1 of the 55 (1.8%) patients with PSC. (P < 0.001) On proportional hazards analysis, UC (hazard ratio (HR) = 0.90 [95% confidence interval (CI): 0.60-1.34, P = 0.60] was not associated with death or orthotopic liver transplantation (OLT), when adjusting for gender, Mayo risk score and year of PSC diagnosis; whereas the revised Mayo risk score [HR = 5.08, 95% CI: (2.62-9.86), P < 0.001] was associated with a greater risk of OLT or death.
  
  
  CONCLUSIONS
  Primary sclerosing cholangitis often is recognised at an early stage in patients with concurrent ulcerative colitis; ulcerative colitis has no impact on long-term prognosis in terms of liver-related outcomes when adjusted for the severity of liver disease.
authors.affiliation: Department of Gastroenterology, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: U
authors.initials: U
authors.lastname: Navaneethan
authors.forename: P G K
authors.initials: PG
authors.lastname: Venkatesh
authors.forename: B A
authors.initials: BA
authors.lastname: Lashner
authors.forename: B
authors.initials: B
authors.lastname: Shen
authors.forename: R P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015209:Cholangitis, Sclerosing / Q000503:physiopathology* / Q000601:surgery; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D055815:Young Adult