Chronic Inflammatory Bowel Disease and Primary Sclerosing Cholangitis: a Unique Duality

Bibliography link: Reyzis A. R., Borzakova S. N. Chronic Inflammatory Bowel Disease and Primary Sclerosing Cholangitis: a Unique Duality. Doctor.Ru. 2017; 12(141): 24–29.
14 November 00:00

Objective of the Review: To raise the level of awareness among researchers and practitioners about the comorbidity of inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC).

Key Points: Based on currently available data, it has been suggested that these conditions, which are mutually exacerbating, especially with respect to conversion to malignancy, be viewed as a dual systemic disorder. Diagnosis of PSC in patients with IBD, as well as the opposite case — detection of IBD in patients with PSC, are extremely challenging and require a thorough targeted examination. Classical treatments, including surgeries such as colectomy or liver transplant, not only fail to improve the situation, but also not infrequently contribute to development of the related condition de novo. At present, preparations containing ursodeoxycholic acid (UDCA) (Ursosan and others) are the only treatment that alleviates this dual condition and reduces the risk of malignancy (colorectal adenoma and cholangiocarcinoma).

Conclusion: For patients with IBD, early detection of concomitant PSC, which is often present as a subclinical disease for a long time, is critically important for the prognosis. Timely initiation of long-term treatment with UDCA medicines improves quality of life and biochemical parameters and reduces the histological activity of the disease process in both the biliary system and the gastrointestinal tract. It may also reduce the rate of conversion of both of these comorbid disorders to malignancy and increase life expectancy.

A. R. Reyzis — Central Research Institute of Epidemiology, Moscow. E-mail:

S. N. Borzakova — N. I. Pirogov Russian National Research Medical University, Moscow. E-mail:

14 November 00:00
  1. Ивашкин В. Т., Буеверов А. О. Аутоиммунные заболевания печени в практике клинициста. М.: М-Вести. 2001: 81–3. [Ivashkin V. T., Bueverov A. O. Autoimmunnye zabolevaniya pecheni v praktike klinitsista, M.: M-Vesti, 2001: 81–3. (in Russian)]
  2. Лейшнер У. Аутоиммунные заболевания печени и перекрестный синдром. М.: Анахарсис; 2005: 160–6. [Leishner U. Autoimmunnye zabolevaniya pecheni i perekrestnyi sindrom. M.: Anakharsis; 2005: 160–6. (in Russian)]
  3. Рейзис А. Р., Никитина Т. С., Дрондина А. К., Матанина Н. В. Патогенетическая терапия вирусных гепатитов, протекающих на фоне соматической патологии у детей. Инфекционные болезни. 2004; 2(3): 45–8. [Reizis A. R., Nikitina T. S., Drondina A. K., Matanina N. V. Patogeneticheskaya terapiya virusnykh gepatitov, protekayushchikh na fone somaticheskoi patologii u detei. Infektsionnye bolezni. 2004; 2(3): 45–8. (in Russian)]
  4. Deneau M., Jensen M. K., Holmen J., Book L. S., Guthery S. L. Primary sclerosing cholangitis, autoimmune hepatitis, and overlap in Utah children: epidemiology and natural history. Hepatology. 2013; 58(4): 1392–400.
  5. Sinakos E., Samuel S., Enders F., Loftus Jr. E. V., Sandborn W. J., Lindor K. D. Inflammatory bowel disease in primary sclerosing cholangitis: a robust yet changing relationship. Inflamm. Bowel Dis. 2013; 19(5): 1004–9.
  6. Ridlon J. M., Bajaj J. S. The human gut sterolbiome: bile acid-microbiome endocrine aspects and therapeutics. Acta Pharm. Sin. B. 2015; 5(2): 99–105.
  7. Chung B. K., Hirschfield G. M. Immunogenetics in primary sclerosing cholangitis. Curr. Opin. Gastroenterol. 2017; 33(2): 93–8.
  8. Jansen P. L., Ghallab A., Vartak N., Reif R., Schaap F. G., Hampe J. et al. The ascending pathophysiology of cholestatic liver disease. Hepatology. 2017; 65(2): 722–38.
  9. Karlsen T. H., Schrumpf E., Boberg K. M. Primary sclerosing cholangitis. Best Pract. Res. Clin. Gastroenterol. 2010; 24(5): 655–66.
  10. Lindor K. D., Kowdley K. V., Harrison M. E.; American College of Gastroenterology. ACG Clinical Guideline: Primary Sclerosing Cholangitis. Am. J. Gastroenterol. 2015; 110(5): 646–59.
  11. Bergquist A., Lindberg G., Saarinen S., Broome U. Increased prevalence of primary sclerosing cholangitis among first-degree relatives. J. Hepatol. 2005; 42(2): 252–6.
  12. Claessen M. M., Vleggaar F. P., Tytgat K. M., Siersema P. D., van Buuren H. R. High lifetime risk of cancer in primary sclerosing cholangitis. J. Hepatol. 2009; 50(1): 158–64.
  13. Wilser V., Gerner R., Moschen A. R., Tilg H. Liver complications in inflammatory bowel diseases. Dig. Dis. 2013; 31(2): 233–8
  14. Tadano T., Kanoh H., Sakamoto K., Kamano T. Kinetic analysis of bile acids in the feces of colorectal cancer patients by gas chromatography-mass spectrometry. Rinsho Byori. 2007; 55(5): 417–27.
  15. Barrasa J. I., Olmo N., Lisarbe M. A., Turnay J. Bile acids in the colon, from healthy to cytotoxic molecules. Toxicol. in Vitro. 2013; 27(2): 964–77.
  16. Pardi D. S., Loftus E. V. Jr., Kremers W. K. Ursodeoxycholic acid as a chemopreventive agent in patients with ulcerative colitis and primary sclerosing cholangitis. Gastroenterology. 2003; 124(4): 889–93.
  17. Peiró-Jordán R., Krishna-Subramanian S., Hanski M. L., Lüscher-Firzlaff J., Zeitz M., Hanski C. The chemopreventive agent ursodeoxycholic acid inhibits proliferation of colon carcinoma cells by suppressing c-Myc expression. Eur. J. Cancer Prev. 2012; 21(5): 413–22.
  18. Tung B. Y., Emond M. J. Haggitt R. C. Ursodiol use is associated with lower prevalence of colonic neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis. Ann. Intern. Med. 2001; 134(2): 89–95.
  19. Wolf J. M., Rybicki L. A., Lashner В. А. The impact of ursodeoxycholic acid on cancer, dysplasia and mortality in ulcerative colitis patients with primary sclerosing cholangitis. Pharmacol. Ther. 2005; 22(9): 783–8.
  20. Heathcote E. J. Diagnosis and management of cholestatic liver disease. Cein. Gastroenterol. Hepatol. 2007; 5(7): 776–82.
  21. Kelly O. B., Mroz M. S., Ward J. B., Colliva C., Scharl M., Pellicciari R. et al J. Ursodeoxycholic acid attenuates colonic epithelial secretory function. Physiol. 2013; 591(9): 2307–18.
  22. Alberts D. S., Martinez M. E., Hess L. M., Einspahr J. G., Green S. B., Bhattacharyya A. K. et al. Phase III trial of ursodeoxycholic acid to prevent colorectal adenoma recurrence. J. Natl. Cancer Inst. 2005; 97(11): 846–53.
  23. Brandsaeter B., Isoniemi H., Broome U., Olausson M., Backman L., Hansen B. et al. Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy. J. Hepatol. 2004; 40(5): 815–22.
  24. Singh S., Khanna S., Pardi D. S., Loftus Jr. E. V., Talwalkar J. A. Effect of Ursodeoxycholic Acid use on the risk of colorectal neoplasia in patients with primary sclerosing cholangitis and Inflammatory bowel disease: a systematic review and meta-analysis. Inflamm. Bowel Dis. 2013; 19(8): 1631–8.
  25. Singh S., Loftus E. V. Jr., Talwalkar J. A. Inflammatory bowel disease after liver transplantation for primary sclerosing cholangitis. Am. J. Gastroenterol. 2013; 108(9): 1417–25.
Новости мировой медицины! Свежие статьи из журнала! Будьте в курсе!

Похожие статьи

Similar article
19 April 00:00, Interview
Doctor.Ru Pediatrics. Vol. 20, No. 3 (2021)
19 April 00:00, Paediatrics
A.V. Aksenov, E.A. Ivanovskaya
Successful Use of Tocilizumab in a Child with Systemic Juvenile Idiopathic Arthritis
Doctor.Ru Pediatrics. Vol. 20, No. 3 (2021)