title: Effect of ursodeoxycholic acid use on the risk of colorectal neoplasia in patients with primary sclerosing cholangitis and inflammatory bowel disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  Ursodeoxycholic acid (UDCA) may modify the risk of inflammatory bowel disease (IBD)-associated colorectal cancer. We performed a systematic review and meta-analysis of studies evaluating the effect of UDCA on the risk of IBD-associated colorectal neoplasia (CRN) (defined as colorectal cancer and/or dysplasia) in patients with primary sclerosing cholangitis with concomitant IBD (PSC-IBD).
  
  
  METHODS
  We conducted a systematic search of Medline, Embase, and Web of Science and manually reviewed the literature. Studies were included if they: (1) evaluated exposure to UDCA in patients with PSC-IBD, (2) reported IBD-associated CRN as outcome, and (3) reported relative risks or odds ratios (ORs) or provided data for their calculation. Summary OR estimates with 95% confidence intervals (CIs) were calculated using the random-effects model.
  
  
  RESULTS
  Eight studies (5 observational, 3 randomized controlled trials) reporting 177 cases of CRN in 763 patients with PSC-IBD were included in the analysis. Overall, meta-analysis showed no significant protective association between UDCA use and CRN (OR, 0.81; 95% CI, 0.41-1.61). However, there was a significant chemopreventive effect on the risk of advanced CRN (colorectal cancer and/or high-grade dysplasia) (OR, 0.35; 95% CI, 0.17-0.73). In a subgroup analysis, low-dose UDCA use (8-15 mg/kg/d) was associated with significant risk reduction of CRN (OR, 0.19; 95% CI, 0.08-0.49).
  
  
  CONCLUSIONS
  UDCA, particularly at low doses, may reduce the risk of advanced CRN in patients with PSC-IBD. However, results should be interpreted with caution, given limited reporting of cancer-related outcomes, primarily from tertiary care centers.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.forename: Sahil
authors.initials: S
authors.lastname: Khanna
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: Jayant A
authors.initials: JA
authors.lastname: Talwalkar
mesh_terms: D006801:Humans; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D015209:Cholangitis, Sclerosing / Q000150:complications; D015179:Colorectal Neoplasms / Q000209:etiology / Q000517:prevention & control; D015212:Inflammatory Bowel Diseases / Q000150:complications; D011379:Prognosis; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid