A comprehensive assessment of environmental exposures among 1000 North American patients with primary sclerosing cholangitis, with and without inflammatory bowel disease

Abstract

SUMMARY Background The relationships between primary sclerosing cholangitis (PSC) and the environment are largely unknown. Aims 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.

Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis

“…Younger patients were less likely to be female, more likely to have concomitant IBD, and more likely to be black, in accordance with prior studies [2–4, 8]. Young individuals were also more commonly listed with a secondary diagnosis of AIH, presumably indicating PSC/AIH overlap syndrome.…”

The gut microbial profile in patients with primary sclerosing cholangitis is distinct from patients with ulcerative colitis without biliary disease and healthy controls

“…With regard to validation of data quality, we were able to reproduce key features of the UC gut microbiota (reduced diversity and depletion of the Akkermansia genus)54 55 and the association between the abundance of Christensenellaceae and BMI 56. A question to be resolved is the importance of missing detailed dietary history in this and other microbiota studies, but no standardised method for adjusting microbiota data using diet exists 57. In the present study, this was handled by removing all individuals reporting to have structured adjustments in their diet, for example, vegetarians and gluten free, but it cannot be excluded that subtle, undetected dietary factors could have influenced our results.…”

Primary Sclerosing Cholangitis

“…In contrast to PSC in the presence of IBD, PSC in the absence of IBD tends to be equally distributed among men and women, is diagnosed at a much older age, 25 and may have a better prognosis. 26 Although the rarity of PSC without IBD limits the power of genetic analysis, this group of PSC patients appears to share similar HLA risk alleles compared to PSC with IBD.…”