Analysis of the disease activity of ulcerative colitis with and without concomitant primary sclerosing cholangitis: An investigation using a nationwide database in Japan

Abstract

Aims Primary sclerosing cholangitis (PSC) is a relatively common complication of ulcerative colitis (UC). Only a few studies have investigated the impact of PSC on the clinical course of UC, and their conclusions are contradictory. Therefore, we aimed to compare the disease activity of UC with and without PSC. Methods and Results We collected UC patient data using the Diagnosis Procedure Combination database system in Japan and classified eligible admissions into two groups based on their diagnosis of either UC alone or UC associated with PSC. We then compared therapeutic details (medical treatment and surgery) between the two groups. Multivariable logistic regression analysis and propensity score matching was also performed. The rates of systemic steroid injection and infliximab administration in patients with PSC were lower than those in patients without PSC (21% vs. 28%, P = 0.012, 9.6% vs. 16%, P = 0.01, respectively). The rates of surgery, colorectal cancer, duration of hospital stay, and in‐hospital mortality did not differ between the two groups. Multivariable analysis revealed that concomitant PSC was a clinical factor that reduced the odds of systemic steroid injection (odds ratio [OR] = 0.66, 95% confidence interval [CI]: 0.49–0.90, P = 0.008) and infliximab (OR = 0.48, 95% CI: 0.32–0.74, P = 0.0008) administration. Conclusion UC patients with PSC might have less UC disease activity than those with UC alone.

The Impact of Concomitant Ulcerative Colitis on the Clinical Course in Patients with Primary Sclerosing Cholangitis: An Investigation Using a Nationwide Database in Japan

“…These results indicate that the disease activity of PSC is not different, regardless of concomitant UC. We previously reported a study regarding the impact of concomitant PSC in patients with UC [14], whose relationship was opposite to that of this study. Our previous study indicated that UC patients with PSC might have lower UC disease activity than patients with UC alone.…”

“…These studies indicate that PSC and UC are expected to have a strong relationship and have the potential to affect each other's clinical course. Several studies have reported that the clinical course of UC associated with PSC is better than that of UC alone [ 9 , 10 , 11 , 12 , 13 , 14 ]. However, little is known about the impact of concomitant UC on the clinical course of PSC.…”

“…Therefore, the PSC-UC association may be better understood by performing an analysis of a large nationwide sample using DPC data. To date, clinical studies have been conducted using the DPC database [ 14 , 16 , 17 , 18 , 19 ]. This study aimed to investigate the impact of concomitant UC on the clinical course of patients with PSC, using a nationwide database in Japan.…”

Depression is associated with increased disease activity in patients with ulcerative colitis: A propensity score‐matched analysis using a nationwide database in Japan

“…We have previously conducted clinical studies on IBD and other lower intestinal tract diseases using the Diagnostic Procedure Combination (DPC) nationwide database. 18 , 19 , 20 , 21 The DPC database contains a large number of admissions and enables analysis of IBD comorbidities, which makes it difficult to collect enough samples for a single‐center study.…”

Severity of acute pancreatitis in patients with inflammatory bowel disease in the era of biologics: A propensity‐score‐matched analysis using a nationwide database in Japan

“…The DPC database contains data for a large number of admissions 11 . This database has been used to conduct investigations targeting primary sclerosing cholangitis as a rare EIM of UC 12 in elderly patients with UC 13 and to evaluate a clinical guideline for AP 14 with sufficient data. Moreover, propensity (PS)‐score‐matched analyses have been performed to evaluate the efficacy of metallic stents for obstructive colorectal cancers and urgent colonoscopy for colonic diverticular bleeding using the same database 15,16 .…”