Concurrent Inflammatory Bowel Disease and Primary Sclerosing Cholangitis: a Review of Pre- and Post-transplant Outcomes and Treatment Options

Overview

Journal Gastroenterol Hepatol Bed Bench

Specialty Gastroenterology

Date 2023 Sep 28

PMID 37767322

Authors

Behzad Hatami

Leila Pasharavesh

Afsaneh Sharifian

Mohammad Reza Zali

Affiliations

Soon will be listed here.

Abstract

Primary Sclerosing Cholangitis (PSC) is a chronic cholestatic liver disease which is associated with Inflammatory Bowel Disease (IBD) in 70% of cases. It seems PSC/IBD is a distinct phenotype that is different from PSC, and IBD alone. Hence, we review the epidemiology, pathogenesis, natural course and management of PSC/IBD before and after LT for PSC. Extensive colitis, rectal sparing, backwash ileitis, and mild symptoms are the characteristics of IBD coexisting with PSC. Moreover, PSC patients with concurrent IBD have higher risk of cholangiocarcinoma, and colorectal neoplasia predominantly in right colon and at younger age. Therefore, it is essential to monitor these individuals continuously. It is interesting to note that the course of IBD (ulcerative colitis) after liver transplantation (LT) for PSC varies greatly, and some patients may develop worsening colitis after LT despite immunosuppressive regimens. As well, management of these patients was discussed in this review.

Citing Articles

Liver transplantation for primary sclerosing cholangitis-morbidities including disease recurrence.

Akamatsu N Hepatobiliary Surg Nutr. 2024; 13(1):143-146.

PMID: 38322208 PMC: 10839727. DOI: 10.21037/hbsn-23-595.

References

Deneau M, El-Matary W, Valentino P, Abdou R, Alqoaer K, Amin M . The natural history of primary sclerosing cholangitis in 781 children: A multicenter, international collaboration. Hepatology. 2017; 66(2):518-527. DOI: 10.1002/hep.29204. View

Chascsa D, Vargas H . The gastroenterologist's guide to management of the post-liver transplant patient. Am J Gastroenterol. 2018; 113(6):819-828. DOI: 10.1038/s41395-018-0049-0. View

Singh S, Loftus Jr E, Talwalkar J . Inflammatory bowel disease after liver transplantation for primary sclerosing cholangitis. Am J Gastroenterol. 2013; 108(9):1417-25. DOI: 10.1038/ajg.2013.163. View

Verdonk R, Haagsma E, van den Berg A, Karrenbeld A, Slooff M, Kleibeuker J . Inflammatory bowel disease after liver transplantation: a role for cytomegalovirus infection. Scand J Gastroenterol. 2006; 41(2):205-11. DOI: 10.1080/00365520500206293. View

Sabino J, Vieira-Silva S, Machiels K, Joossens M, Falony G, Ballet V . Primary sclerosing cholangitis is characterised by intestinal dysbiosis independent from IBD. Gut. 2016; 65(10):1681-9. PMC: 5036217. DOI: 10.1136/gutjnl-2015-311004. View

Ueda Y, Kaido T, Okajima H, Hata K, Anazawa T, Yoshizawa A . Long-term Prognosis and Recurrence of Primary Sclerosing Cholangitis After Liver Transplantation: A Single-Center Experience. Transplant Direct. 2018; 3(12):e334. PMC: 5828688. DOI: 10.1097/TXD.0000000000000751. View

Alabraba E, Nightingale P, Gunson B, Hubscher S, Olliff S, Mirza D . A re-evaluation of the risk factors for the recurrence of primary sclerosing cholangitis in liver allografts. Liver Transpl. 2009; 15(3):330-40. DOI: 10.1002/lt.21679. View

Braden B, Halliday J, Aryasingha S, Sharifi Y, Checchin D, Warren B . Risk for colorectal neoplasia in patients with colonic Crohn's disease and concomitant primary sclerosing cholangitis. Clin Gastroenterol Hepatol. 2011; 10(3):303-8. DOI: 10.1016/j.cgh.2011.10.020. View

Lindstrom L, Lapidus A, Ost A, Bergquist A . Increased risk of colorectal cancer and dysplasia in patients with Crohn's colitis and primary sclerosing cholangitis. Dis Colon Rectum. 2011; 54(11):1392-7. DOI: 10.1097/DCR.0b013e31822bbcc1. View

10.

Karlsen T, Folseraas T, Thorburn D, Vesterhus M . Primary sclerosing cholangitis - a comprehensive review. J Hepatol. 2017; 67(6):1298-1323. DOI: 10.1016/j.jhep.2017.07.022. View

11.

Wang R, Leong R . Primary sclerosing cholangitis as an independent risk factor for colorectal cancer in the context of inflammatory bowel disease: a review of the literature. World J Gastroenterol. 2014; 20(27):8783-9. PMC: 4112886. DOI: 10.3748/wjg.v20.i27.8783. View

12.

van de Vrie W, de Man R, van Buuren H, Ruud Schouten W, Tilanus H, Metselaar H . Inflammatory bowel disease and liver transplantation for primary sclerosing cholangitis. Eur J Gastroenterol Hepatol. 2003; 15(6):657-63. DOI: 10.1097/00042737-200306000-00013. View

13.

Mertz A, Nguyen N, Katsanos K, Kwok R . Primary sclerosing cholangitis and inflammatory bowel disease comorbidity: an update of the evidence. Ann Gastroenterol. 2019; 32(2):124-133. PMC: 6394256. DOI: 10.20524/aog.2019.0344. View

14.

Mazza S, Soro S, Verga M, Elvo B, Ferretti F, Cereatti F . Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders. World J Hepatol. 2022; 13(12):1828-1849. PMC: 8727201. DOI: 10.4254/wjh.v13.i12.1828. View

15.

Chapman R, Fevery J, Kalloo A, Nagorney D, Boberg K, Shneider B . Diagnosis and management of primary sclerosing cholangitis. Hepatology. 2010; 51(2):660-78. DOI: 10.1002/hep.23294. View

16.

Worns M, Lohse A, Neurath M, Croxford A, Otto G, Kreft A . Five cases of de novo inflammatory bowel disease after orthotopic liver transplantation. Am J Gastroenterol. 2006; 101(8):1931-7. DOI: 10.1111/j.1572-0241.2006.00624.x. View

17.

Lee W, Karthik S, Ng R, Ong S, Ong C, Chiou F . Characteristics and outcome of primary sclerosing cholangitis associated with inflammatory bowel disease in Asian children. Pediatr Neonatol. 2019; 60(4):396-404. DOI: 10.1016/j.pedneo.2018.09.007. View

18.

Westerouen van Meeteren M, Hayee B, Inderson A, van der Meulen A, Altwegg R, Van Hoek B . Safety of Anti-TNF Treatment in Liver Transplant Recipients: A Systematic Review and Meta-analysis. J Crohns Colitis. 2017; 11(9):1146-1151. DOI: 10.1093/ecco-jcc/jjx057. View

19.

Milosevic I, Russo E, Vujovic A, Barac A, Stevanovic O, Gitto S . Microbiota and viral hepatitis: State of the art of a complex matter. World J Gastroenterol. 2021; 27(33):5488-5501. PMC: 8433613. DOI: 10.3748/wjg.v27.i33.5488. View

20.

Moncrief K, Savu A, Ma M, Bain V, Wong W, Tandon P . The natural history of inflammatory bowel disease and primary sclerosing cholangitis after liver transplantation--a single-centre experience. Can J Gastroenterol. 2010; 24(1):40-6. PMC: 2830633. DOI: 10.1155/2010/830291. View