Cigarette smoking, appendectomy, and tonsillectomy as risk factors for the development of primary sclerosing cholangitis: a case control study

Mitchell, Stephen; Thyssen, M; Orchard, Tim; Jewell, D P; Fleming, K. A.; Chapman, Roger W.

doi:10.1136/gut.51.4.567

Cited by 96 publications

(63 citation statements)

References 43 publications

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“…Moreover, this protective effect was more marked in patients with primary sclerosing cholangitis than ulcerative colitis and was seen in patients with and without inflammatory bowel disease [29][30][31] . The mechanism of protection in both disorders remains unknown.…”

Section: Risk Factorsmentioning

confidence: 95%

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Saich¹,

Chapman²

2008

WJG

117

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(AIH) is also more prevalent in patients with IBD, with up to 16% of patients with AIH also having ulcerative colitis. A small subgroup of patients have a AIH-PSC overlap syndrome and the management of these patients depends on liver histology, serum IgM levels, autoantibodies, degree of biochemical cholestasis and cholangiography as some of these patients may respond to immunosupression. INTRODUCTIONThe first association between colonic ulceration and liver disease was made in 1874 by Thomas CH, who described a young man who died of a 'much enlarged, fatty liver in the presence of ulceration of the colon' [1] . The association was confirmed by James Lister in 1899, who reported a patient with ulcerative colitis and secondary diffuse hepatitis [2] . Over the next 100 years it has become well established that there is a close relationship between inflammatory bowel disease and various hepatobiliary disorders. These disorders are listed in Table 1. PRIMARY SCLEROSING CHOLANGITISFirst described by Smith and Loe in 1965 [3] Primary sclerosing cholangitis (PSC) is a chronic progressive disorder of unknown aetiology characterised by inflammation, fibrosis and stricture formation in medium and large sized ducts in the biliary tree [4,5] . Common symptoms include itch and lethargy although many patients (up to 45%) are asymptomatic, even with advanced disease [5] . The disease is strongly associated with Inflammatory Bowel Disease and may be detected as an incidental finding of a raised serum alkaline phosphatase. www.wjgnet.comRe b e c c a S a i c h , Ro g e r C h a p m a n , AbstractPrimary sclerosing cholangitis (PSC) is a chronic progressive disorder of unknown aetiology characterised by chronic inflammation and stricture formation of the biliary tree.

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Section: Risk Factorsmentioning

confidence: 95%

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Saich¹,

Chapman²

2008

WJG

117

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“…One study found that current cigarette smoking in UC patients increased the risk of articular and dermatological EIMs, whereas no such increase was observed in ocular or hepatobiliary complications. 38 Current or previous smoking has also been shown to reduce instances of primary sclerosing cholangitis 1,5,6,24,[39][40][41] and backwash ileitis. 24 The literature remains divided, however, regarding smoking's effect on pouchitis following colectomy with ileal pouch-anal anastomosis.…”

Section: 21mentioning

confidence: 99%

Review article: ulcerative colitis, smoking and nicotine therapy

Lunney

Leong

2012

Aliment Pharmacol Ther

121

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SummaryBackgroundSmoking is the best‐characterised environmental association of ulcerative colitis (UC). Smoking has been observed to exert protective effects on both the development and progression of UC.AimsTo examine the association between UC and smoking, possible pathogenic mechanisms and the potential of nicotine as a therapeutic agent in the treatment of UC.MethodsA literature search was conducted through MEDLINE, using the MeSH search terms ‘ulcerative colitis’ and ‘smoking’ or ‘nicotine’. Relevant articles were identified through manual review. The reference lists of these articles were reviewed to include further appropriate articles.ResultsUlcerative colitis is less prevalent in smokers. Current smokers with a prior diagnosis of UC are more likely to exhibit milder disease than ex‐smokers and nonsmokers. There is conflicting evidence for smokers having reduced rates of hospitalisation, colectomy and need for oral corticosteroids and immunosuppressants to manage their disease. Multiple potential active mediators in smoke may be responsible for these clinical effects, including nicotine and carbon monoxide, but the precise mechanism remains unknown. Nicotine has demonstrated variable efficacy in the induction of remission in UC when compared to placebo and conventional medicines. Despite this, the high frequency of adverse events limits its clinical significance.ConclusionsNicotine's application as a therapeutic treatment in ulcerative colitis is limited. Presently, it may be an option considered only in selected cases of acute ulcerative colitis refractory to conventional treatment options. This review also questions whether nicotine is the active component of smoking that modifies risk and inflammation in ulcerative colitis.

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“…Environmental factors are also involved with the absence of cigarette smoking appearing to be a predisposing risk factor [7,8], which is independent of the presence of IBD. In one study, only 4.9% of patients with PSC smoked compared with 26.1% of controls [9].…”

Section: Epidemiologymentioning

confidence: 99%

Primary Sclerosing Cholangitis

Williamson

Chapman

2014

Dig Dis

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Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver disease caused by diffuse inflammation and fibrosis that can involve the entire biliary tree. It is a progressive disorder which can ultimately lead to biliary cirrhosis, portal hypertension and hepatic failure. PSC is a complex genetic disorder with male predominance. Environmental predisposing factors include non-smoking. It is closely associated with inflammatory bowel disease (IBD), particularly ulcerative colitis, which occurs in about two thirds of PSC cases. Recent studies have suggested that PSC-IBD is a separate disease entity from IBD alone with distinctive genetic and phenotypic characteristics. Most PSC patients are asymptomatic at presentation; clinical symptoms include fatigue, jaundice, weight loss, right upper quadrant pain and pruritis. Serum biochemical tests indicate cholestasis, and diagnosis is usually established by cholangiography. In symptomatic patients, median survival from presentation to death or liver transplantation is about 12 years. It is a premalignant condition, and the majority of deaths are from malignancy, particularly cholangiocarcinoma or colonic cancer. PSC has no curative treatment. Medical treatment with ursodeoxycholic acid may slow progression of the disease and reduce colonic dysplasia, though trials lack statistical significance. Liver transplantation is the only option in young patients with PSC and advanced liver disease.

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Cigarette smoking, appendectomy, and tonsillectomy as risk factors for the development of primary sclerosing cholangitis: a case control study

Cited by 96 publications

References 43 publications

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Review article: ulcerative colitis, smoking and nicotine therapy

Primary Sclerosing Cholangitis

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