Effect of proctocolectomy for chronic ulcerative colitis on the natural history of primary sclerosing cholangitis

Cangemi, John R.; Wiesner, Russell H.; Beaver, Sandra J.; Ludwig, Jürgen; MacCarty, Robert L.; Dozois, Roger R.; Zinsmeister, Alan R.; LaRusso, Nicholas F.

doi:10.1016/0016-5085(89)90903-7

Cited by 88 publications

(52 citation statements)

References 17 publications

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“…Such findings are consistent with those of the prospective study reported by Cangemi et al [2]who showed the natural history of PSC and survival did not differ whether patients underwent proctocolectomy or were treated medically.…”

Section: Discussionsupporting

confidence: 83%

“…Primary sclerosing cholangitis was included whenever a histologic diagnosis was obtained prior to or at the time of surgery and after exclusion of any other hepatobiliary diseases. Histologic diagnosis had to be confirmed by radiologic criteria demonstrating beading of the intra- and extrahepatic biliary tree [2]. The evolution was assessed based on the subjective responses to the questionnaire sent patients regarding the state of their disease and not always based on histologic or biologic criteria.…”

Section: Patient Population and Methodsmentioning

confidence: 99%

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Characteristics and Evolution of Extraintestinal Manifestations Associated with Ulcerative Colitis after Proctocolectomy

et al. 2001

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Aims: Describe the characteristics of extraintestinal manifestations complicating ulcerative colitis present preoperatively and determine their evolution after surgery. Methods: Between 1976 and 1986, 281 patients with ulcerative colitis exhibiting one or more extraintestinal manifestations (EIM) before either IPAA (n = 147), Brooke ileostomy (n = 71), Kock pouch (n = 48) or ileorectostomy (n = 15) were assessed retrospectively. The clinical evolution of each manifestation was classified as having disappeared, improved, remained unchanged or aggravated postoperatively. An efficacy index was designed to assess the ratio of the number of cases cured or improved over the number of cases unchanged or aggravated. The relationship between EIM and gender, age, duration of disease and the type of surgery was also ascertained. Results: 433 EIM were observed in 281 patients. The most common were arthralgias of the large joints (n = 146), of the sacroiliac joint (n = 59) and the small joints (n = 51). In comparison to patients without EIM having received the same operation during the same period of time, EIM were seen more often in women, younger patients, than those with longer duration of disease and the ileoanal anastomosis group. 60% had only one EIM at a time. Based on the efficacy index, thromboembolic accidents and erythema nodosum were the most commonly cured or improved. Ocular manifestations and primary sclerosing cholangitis were unaffected. The other EIM responded favorably but variably with improvement in two thirds of patients. The presence of a rectal remnant (IRA) or ileal reservoir did not affect the evolution of the EIM. Conclusions: Thromboembolic complications which are life-threatening, erythema nodosum and arthralgia of the small and large joints which impair quality of life, benefited the most from proctocolectomy. Those conditions may be considered preoperatively when making the decision for surgery.

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Section: Discussionsupporting

confidence: 83%

Section: Patient Population and Methodsmentioning

confidence: 99%

Characteristics and Evolution of Extraintestinal Manifestations Associated with Ulcerative Colitis after Proctocolectomy

et al. 2001

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“…Proctocolectomy appears to have no effect on liver biochemistry, histology or survival of patients with PSC and chronic UC [67] . However the natural history of UC following liver transplantation is variable [68][69][70][71][72] .…”

Section: Psc Treatmentmentioning

confidence: 99%

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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“…33,34 Histological data from a inflammatory bowel disease is well recognized. [8][9][10][11][12] Recent liver biopsy performed within 6 months of entry into the study was studies have implicated genetic and immunological mechaused in calculating the DSM score. Ludwig's criteria 38,39 were used nisms as factors in its pathogenesis.…”

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confidence: 99%

The Child-Pugh classification as a prognostic indicator for survival in primary sclerosing cholangitis

1997

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majority of these models involve invasive tests and have Clinical decisions in primary sclerosing cholangitis never been demonstrated to be superior to more simple, dis-(PSC) depend upon understanding its variable natural ease-nonspecific approaches. We sought to determine if the history. Several prognostic models for survival haveChild-Pugh Classification (CPC), [30][31][32] with its ready applicabeen developed. We explored the Child-Pugh Classificability to clinical practice, provides a similar degree of accution (CPC) to determine if it predicts survival as well as racy in estimating survival as the most widely used diseasea disease-specific model (DSM). We identified 208 PSC specific model (DSM rhage, splenomegaly, and encephalopathy. Patients who reported nonspecific complaints such as fatigue, weight loss, or anorexia were classified as being asymptomatic. All blood tests were completed Primary sclerosing cholangitis (PSC) is a chronic chole-using standard laboratory techniques at the Cleveland Clinic. Cholstatic disease that is characterized by inflammation and fi-angiographic evidence of PSC included multifocal, diffuse strictures with alternating normal or dilated segments that produced a characbrosis of the intra-and extrahepatic bile ducts. 1-5 The etiology teristic ''beaded'' appearance and mural irregularities, involving both of PSC remains unknown, 6,7 although its relationship with the intra-and extrahepatic bile ducts. 33,34 Histological data from a inflammatory bowel disease is well recognized. [8][9][10][11][12] Recent liver biopsy performed within 6 months of entry into the study was studies have implicated genetic and immunological mechaused in calculating the DSM score. Ludwig's criteria 38,39 were used nisms as factors in its pathogenesis. [13][14][15] PSC is a progressive in the staging of liver biopsy specimens. For purposes of statistical disease in most individuals 16,17 advancing at a variable rate analyses, numerical values were allotted to various stages, as in towards bile duct obliteration, biliary cirrhosis, and hepatic earlier studies (the value: 1 for stages 1 and 2; 2 for stage 3; and 4 failure. No effective treatment for this disorder has been iden-for stage 4). 29 tified, 18-22 and orthotopic liver transplantation remains the Predictive Models: CPC. 30-32 We used the Pugh modification of the classification originally proposed by Child and Turcotte, both with only option for those with end-stage disease. [23][24][25] and without the variation developed for cholestatic disease. The DSM Accurate methods of estimating survival in PSC are of imto which we compared the CPC employs the following four variables: portance in the context of classifying patients in therapeutic log e bilirubin, histological stage, age, and presence of splenomegaly. trials and in the decision-making process regarding the timThe DSM is used to predict the probability of surviving 1 to 7 ing and candidacy of orthotopic liver transplantation in eligi-years. 27,29 ble individuals. Disease-specific multivari...

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Effect of proctocolectomy for chronic ulcerative colitis on the natural history of primary sclerosing cholangitis

Cited by 88 publications

References 17 publications

Characteristics and Evolution of Extraintestinal Manifestations Associated with Ulcerative Colitis after Proctocolectomy

Characteristics and Evolution of Extraintestinal Manifestations Associated with Ulcerative Colitis after Proctocolectomy

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

The Child-Pugh classification as a prognostic indicator for survival in primary sclerosing cholangitis

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