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P060. Does the development of primary sclerosing cholangitis in IBD require the presence of colonic inflammation?

A.M. O'Toole, A. Alakkari, D. Keegan, G.A. Doherty, H. Mulcahy, D. O'Donoghue

St Vincents University Hospital, Dublin, Ireland

Introduction: The association between primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) is well established. Inflammation with bacterial translocation to the liver has been implicated in PSC development, suggesting that the site of inflammation within the bowel might be important. The intestinal microflora differs from small to large bowel with the small bowel considered largely sterile, but the relationship between site of IBD inflammation in and the development of PSC is not known.

Aims: To determine if the distribution of intestinal inflammation in IBD is associated with the development of PSC.

Methods: The study included 2,510 patients with inflammatory bowel diseases (mean age at diagnosis 35 years (range 4–92); 1,237 male, 1,273 female). Data were retrieved from a prospectively maintained database of IBD/PSC patients. 78 tertiary referrals with PSC to the Liver Unit were also analysed (36 PSC patients without clinical or endoscopic evidence of IBD were subsequently excluded) leaving 2,474 for analysis.

Results: 102 patients (4.1%) had PSC in addition to IBD. Eighty-one of 1,446 ulcerative colitis patients (5.6%) had PSC compared with 21 of 1,028 (2.0%) with Crohn's disease (p < 0.001). In the Crohn's disease subgroup, 378 (37%) had isolated colonic disease, 357 (35%) had ileo-colonic disease and 293 (29%) had isolated small bowel disease. Rates of PSC were 2.9% (11/378) in isolated colonic disease, 2.8% (10/357) in ileo-colonic disease and 0% (0/293) in isolated small bowel disease (p = 0.01).

Conclusion: The absence of PSC in patients with isolated small bowel Crohn's disease provides strong clinical validation of the concept that colonic mucosal inflammation plays a fundamental role in the pathogenesis of PSC in patients with IBD.