title: A comprehensive assessment of environmental exposures among 1000 North American patients with primary sclerosing cholangitis, with and without inflammatory bowel disease.
abstract: BACKGROUND
  The relationships between primary sclerosing cholangitis (PSC) and the environment are largely unknown.
  
  
  OBJECTIVE
  To validate associations reported in previous studies and to identify novel environmental exposures among PSC patients.
  
  
  METHODS
  We performed a multicenter, case-control analysis utilising self-administered questionnaires. Responses between cases (n = 1000) and controls (n = 663) were compared using multivariable logistic regression adjusted for age and gender. The model was further stratified based on inflammatory bowel disease (IBD) status (with IBD n = 741 without IBD n = 259).
  
  
  RESULTS
  Smoking was associated with PSC only when IBD was present (OR, 0.5; 95% CI 0.4-0.7) but not among those PSC patients without IBD (OR, 0.9; 95% CI 0.7-1.2). Compared to controls, women with PSC (irrespective of the presence of IBD) were less likely to have received hormone replacement therapy (HRT; OR, 0.5; 95% CI 0.4-0.7) and were more likely to have recurrent urinary tract infections (OR, 1.6; 95% CI 1.2-2.3). PSC patients regardless of gender or IBD status were less likely to eat fish (OR, 0.4; 95% CI 0.3-0.6) and grilled/barbecued meat (OR, 0.8; 95% CI 0.7-0.9). In contrast, PSC patients with and without IBD were more likely to consume steak/burgers that were more well done (OR, 1.3; 95% CI 1.2-1.5).
  
  
  CONCLUSIONS
  IBD (rather than PSC) is associated with smoking. Women with PSC are more likely to have recurrent urinary tract infections and less likely to receive HRT. Dietary intake and methods of food preparation differ in PSC patients when compared to controls.
authors.affiliation: Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Eaton
authors.forename: B D
authors.initials: BD
authors.lastname: Juran
authors.forename: E J
authors.initials: EJ
authors.lastname: Atkinson
authors.forename: E M
authors.initials: EM
authors.lastname: Schlicht
authors.forename: X
authors.initials: X
authors.lastname: Xie
authors.forename: M
authors.initials: M
authors.lastname: de Andrade
authors.forename: C S
authors.initials: CS
authors.lastname: Lammert
authors.forename: V A
authors.initials: VA
authors.lastname: Luketic
authors.forename: J A
authors.initials: JA
authors.lastname: Odin
authors.forename: A A
authors.initials: AA
authors.lastname: Koteish
authors.forename: K V
authors.initials: KV
authors.lastname: Kowdley
authors.forename: K B
authors.initials: KB
authors.lastname: Chopra
authors.forename: G M
authors.initials: GM
authors.lastname: Hirschfield
authors.forename: N P
authors.initials: NP
authors.lastname: Chalasani
authors.forename: K N
authors.initials: KN
authors.lastname: Lazaridis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D015209:Cholangitis, Sclerosing / Q000453:epidemiology* / Q000209:etiology; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult