Colectomy prior to diagnosis of primary sclerosing cholangitis is associated with improved prognosis in a nationwide cohort study of 2594 PSC‐IBD patients
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Summary: Background: Despite the close relationship between primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD), the association between colectomy and the prognosis of PSC remains controversial. Aim: To explore whether colectomy prior to PSC‐diagnosis is associated with transplant‐free survival. Methods: A nationwide cohort study in Sweden including all patients aged 18 to 69 years in whom both PSC and IBD was diagnosed between 1987 and 2014 was undertaken. Each patient was followed from date of both PSC and IBD diagnoses until liver transplantation or death, or 31 December 2014. Patients with colon in situ, and colectomy prior to PSC‐diagnosis were compared. Survival analyses were performed using the Kaplan‐Meier method and multivariable Cox regression models. Results: Of the 2594 PSC‐IBD patients, 205 patients were treated with colectomy before PSC‐diagnosis. During follow‐up, liver transplantations were performed in 327 patients and 509 died. The risk of liver transplantation or death was lower in patients treated with colectomy prior to PSC‐diagnosis (HR 0.71, 95% CI 0.53‐0.95) than in patients with colon in situ. Male gender, longer time between IBD and PSC‐diagnosis and older age were all associated with an increased risk of liver transplantation or death. Colectomy after PSC‐diagnosis was however not associated with an increased risk of liver transplantation or death during long‐term follow‐up. Conclusions: In PSC‐IBD patients, colectomy prior to PSC‐diagnosis is associated with a decreased risk of liver transplantation or death.
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The close relationship between PSC and inflammatory bowel disease is likely relevant, as shown by variable disease behaviour depending on the clinical presentation of inflammatory bowel disease.
“The close relationship with IBD is likely relevant, as shown by variable disease behaviour depending on the clinical presentation of IBD.6,8”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [8]
A lower platelet count and higher total bilirubin at 2 years were associated with an increased risk of developing new varices in the 25 patients (20%) who developed new varices.
“Moreover, a lower platelet count and higher total bilirubin at 2 years were associated with an increased risk of developing new varices in the 25 patients (20%) who developed new varices (8).”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [8]
Colectomy in people with PSC-IBD is associated with a more favourable outcome.
“Other potential evidence that gut inflammation may affect PSC progression is the association between a more favourable outcome in people with PSC-IBD undergoing colectomy.8”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [8]
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- Authors
- Nordenvall, C., Olén, O., Nilsson, P. J., von Seth, E., Ekbom, A., Bottai, M., Myrelid, P., & Bergquist, A.
- Affiliations
- Karolinska University Hospital (SE)
- Karolinska Institutet (SE)
- Department of Medicine Huddinge Division of Hepatology Karolinska Institutet Center for Digestive Disease Karolinska University Hospital Stockholm Sweden
- Linköping University (SE)
- Corresponding author
- Nordenvall, C.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2017-10-24
- Volume
- 47
- Issue
- 2
- Pages
- 238-245
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2765761785
- Cited by
- 78
- References
- 37
- Citations by year
- 2026: 13 · 2025: 9 · 2024: 10 · 2023: 11 · 2022: 5 · 2021: 5 · 2020: 5 · 2019: 8 · 2018: 11
- FWCI
- 4.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cancerfonden
- Stockholms Läns Landsting
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
- Keywords
- primary sclerosing cholangitis, inflammatory bowel disease, colectomy, transplant-free survival, liver transplantation, mortality, prognosis
- MeSH terms
- Adolescent, Adult, Aged, Colectomy, Female, Graft Survival, Humans, Male, Middle Aged, Prognosis, Sweden, Cholangitis, Sclerosing, Inflammatory Bowel Diseases, Cohort Studies, Survival Analysis, Liver Transplantation, Treatment Outcome, Young Adult
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