Aida Kapic Lunder1, Johannes Roksund Hov2, Arne Borthne3, Jostein Gleditsch4, Glenn Johannesen5, Knut Tveit6, Ellen Viktil7, Magne Henriksen8, Øistein Hovde9, Gert Huppertz-Hauss10, Ole Høie11, Marte Lie Høivik12, Iril Monstad13, Inger Camilla Solberg12, Jørgen Jahnsen14, Tom Hemming Karlsen2, Bjørn Moum13, Morten Vatn15, Anne Negård16. 1. Department of Radiology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: aida.k.lunder@gmail.com. 2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Section for Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; K. G. Jebsen Inflammation Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 3. Department of Radiology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. 4. Department of Radiology, Østfold Hospital, Fredrikstad, Norway. 5. Department of Radiology, Telemark Hospital, Skien, Norway. 6. Røntgensenteret, Kristiansand, Norway. 7. Department of Radiology, Oslo University Hospital, Ullevål, Oslo, Norway. 8. Department of Gastroenterology, Østfold Hospital, Fredrikstad, Norway. 9. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Gastroenterology, Innlandet Hospital, Gjøvik, Norway. 10. Department of Gastroenterology, Telemark Hospital, Skien, Norway. 11. Department of Gastroenterology, Sørlandet Hospital, Arendal, Norway. 12. Department of Gastroenterology, Division of Medicine, Oslo University Hospital, Ullevål, Oslo, Norway. 13. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Gastroenterology, Division of Medicine, Oslo University Hospital, Ullevål, Oslo, Norway. 14. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway. 15. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; EpiGen Institute, Akershus University Hospital, Lørenskog, Norway. 16. Department of Radiology, Akershus University Hospital, Lørenskog, Norway; Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Abstract
BACKGROUND & AIMS: The prevalence of primary sclerosing cholangitis (PSC) among patients with inflammatory bowel disease (IBD) is unclear. Patients with IBD might be screened for PSC using magnetic resonance cholangiography (MRC). We aimed to estimate the frequency and distribution of MRC-detected lesions that indicate PSC in patients with IBD 20 years after their initial diagnosis and to identify clinical characteristics associated with these findings. METHODS: We performed a follow-up analysis of a population-based cohort of 756 patients in South-Eastern Norway diagnosed with IBD from January 1, 1990 through December 31, 1993. Of these subjects, 470 attended a follow-up evaluation 20 years later in which they were offered routine clinical blood testing and ileocolonoscopy; 322 were screened by MRC (222 with ulcerative colitis and 100 with Crohn's disease). Two radiologists independently evaluated results from the MRC examinations. RESULTS: In the MRC examination, 24 patients (7.5%) were found to have PSC-like lesions; only 7 of these patients (2.2%) were known to have PSC. One patient was initially missed and 1 had small-duct PSC, so the final prevalence of PSC was 8.1%. Extensive colitis, a high prevalence of colectomy, and chronic and continuous symptoms of IBD occurred in significantly more patients with suspected PSC than without PSC (P = .029, P = .002, and P = .012, respectively). Among patients with subclinical features of PSC, the MRC progression score for PSC increased when they were re-examined after a median 3.2 years (P = .046). CONCLUSIONS: Using MRC analysis of patients with long-term IBD, we found the prevalence of PSC to be around 3-fold higher than that detected based on symptoms. Sixty-five percent of patients had subclinical PSC associated with progressive IBD, with no biochemical abnormalities and mild disease, based on radiology findings. PSC appears to progress in patients with subclinical disease, but long-term outcomes are not known.
BACKGROUND & AIMS: The prevalence of primary sclerosing cholangitis (PSC) among patients with inflammatory bowel disease (IBD) is unclear. Patients with IBD might be screened for PSC using magnetic resonance cholangiography (MRC). We aimed to estimate the frequency and distribution of MRC-detected lesions that indicate PSC in patients with IBD 20 years after their initial diagnosis and to identify clinical characteristics associated with these findings. METHODS: We performed a follow-up analysis of a population-based cohort of 756 patients in South-Eastern Norway diagnosed with IBD from January 1, 1990 through December 31, 1993. Of these subjects, 470 attended a follow-up evaluation 20 years later in which they were offered routine clinical blood testing and ileocolonoscopy; 322 were screened by MRC (222 with ulcerative colitis and 100 with Crohn's disease). Two radiologists independently evaluated results from the MRC examinations. RESULTS: In the MRC examination, 24 patients (7.5%) were found to have PSC-like lesions; only 7 of these patients (2.2%) were known to have PSC. One patient was initially missed and 1 had small-duct PSC, so the final prevalence of PSC was 8.1%. Extensive colitis, a high prevalence of colectomy, and chronic and continuous symptoms of IBD occurred in significantly more patients with suspected PSC than without PSC (P = .029, P = .002, and P = .012, respectively). Among patients with subclinical features of PSC, the MRC progression score for PSC increased when they were re-examined after a median 3.2 years (P = .046). CONCLUSIONS: Using MRC analysis of patients with long-term IBD, we found the prevalence of PSC to be around 3-fold higher than that detected based on symptoms. Sixty-five percent of patients had subclinical PSC associated with progressive IBD, with no biochemical abnormalities and mild disease, based on radiology findings. PSC appears to progress in patients with subclinical disease, but long-term outcomes are not known.
Authors: Tobias J Weismüller; Palak J Trivedi; Annika Bergquist; Mohamad Imam; Henrike Lenzen; Cyriel Y Ponsioen; Kristian Holm; Daniel Gotthardt; Martti A Färkkilä; Hanns-Ulrich Marschall; Douglas Thorburn; Rinse K Weersma; Johan Fevery; Tobias Mueller; Olivier Chazouillères; Kornelius Schulze; Konstantinos N Lazaridis; Sven Almer; Stephen P Pereira; Cynthia Levy; Andrew Mason; Sigrid Naess; Christopher L Bowlus; Annarosa Floreani; Emina Halilbasic; Kidist K Yimam; Piotr Milkiewicz; Ulrich Beuers; Dep K Huynh; Albert Pares; Christine N Manser; George N Dalekos; Bertus Eksteen; Pietro Invernizzi; Christoph P Berg; Gabi I Kirchner; Christoph Sarrazin; Vincent Zimmer; Luca Fabris; Felix Braun; Marco Marzioni; Brian D Juran; Karouk Said; Christian Rupp; Kalle Jokelainen; Maria Benito de Valle; Francesca Saffioti; Angela Cheung; Michael Trauner; Christoph Schramm; Roger W Chapman; Tom H Karlsen; Erik Schrumpf; Christian P Strassburg; Michael P Manns; Keith D Lindor; Gideon M Hirschfield; Bettina E Hansen; Kirsten M Boberg Journal: Gastroenterology Date: 2017-03-06 Impact factor: 22.682
Authors: John E Eaton; Bryan M McCauley; Elizabeth J Atkinson; Brian D Juran; Erik M Schlicht; Mariza de Andrade; Konstantinos N Lazaridis Journal: J Gastroenterol Hepatol Date: 2017-10 Impact factor: 4.029