title: Comparison of outcomes for patients with primary sclerosing cholangitis associated with ulcerative colitis and Crohn's disease.
abstract: BACKGROUND
  The comparative outcomes of ulcerative colitis (UC) and Crohn's disease (CD) in patients with primary sclerosing cholangitis (PSC) are unclear; the aim of our study was to make an objective comparison.
  
  
  METHODS
  A total of 273 patients with PSC and inflammatory bowel disease (223 with UC and 50 with CD) were included. Clinical and demographic variables were obtained.
  
  
  RESULTS
  The PSC risk score was similar for both groups. The median follow-up period in patients with PSC-UC was 12 years (range 0-38) and that for PSC-CD was 14 years (range 1-36). The median number of disease flares per year was higher in PSC-UC patients than in the PSC-CD group [1vs.0 (ranges 0-20 and 0-9, respectively); P < 0.001]. More patients with UC developed colon neoplasia than CD (35.9% vs.18%; P = 0.009). On proportional hazards analysis for the risk of colectomy, UC patients had a 12% higher risk for colectomy [hazard ratio (HR) = 0.88; 95% confidence interval (CI) 0.51-1.51; P = 0.64]. Liver transplantation for PSC was associated with decreased risk (HR = 0.57; 95% CI 0.37-0.89; P = 0.013), while colon neoplasia increased the risk (HR = 3.83; 95% CI 2.63-5.58; P < 0.001) for colectomy. On proportional hazards analysis for the risk of colon neoplasia, UC patients had 56% higher risk of developing colon neoplasia than CD (HR = 0.44; 95% CI 0.16-1.25; P = 0.12).
  
  
  CONCLUSIONS
  PSC patients with CD appear to be associated with a lower risk of colon neoplasia and colectomy than PSC patients with UC.
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA udhaykumar81@gmail.com.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Preethi Gk
authors.initials: PG
authors.lastname: Venkatesh
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Jegadeesan
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Vennisvasanth
authors.initials: V
authors.lastname: Lourdusamy
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Hammel
authors.affiliation: Department of Colorectal Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
keywords: Crohn’s disease; colectomy; colon neoplasia; liver transplantation; primary sclerosing cholangitis; ulcerative colitis