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P316. A distinct phenotype of ulcerative colitis in patients with primary sclerosing cholangitis: a single centre retrospective-descriptive analysis

A. Crudeli1, C. Finlayson2, J. Vlahos3, D. Forton1, R. Pollok1, 1St. George's Medical School, Dept. of Gastroenterology, St George's Healthcare NHS Trust, London, United Kingdom, 2St. George's Medical School, Dept. of Histopathology St George's Healthcare NHS Trust, London, United Kingdom, 3St. George's Medical School, Dept. of Radiology, St George's Healthcare NHS Trust, London, United Kingdom

Background

PSC (Primary Sclerosing Cholangitis) is a chronic cholestatic liver disease associated in 70–80% of cases with UC (ulcerative Colitis). In UC patients PSC remains, together with active longstanding colitis, the most important risk factor for developing CRC (colo-rectal cancer). Previous studies have suggested a distinct pattern of UC in patients with PSC. The aim of our analysis was to define the epidemiology and the clinical and histological phenotype of UC in a small population of patients with PSC at a London tertiary referral centre.

Methods

Three databases (radiological, clinical and pathological) were scrutinised and epidemiological, clinical and histological features recorded and analyzed. To assess the overall grade of colitis a mean total histopathology score was calculated for each patient categorised into three subgroups: mild, moderate and severe.

Results

Between 1995–2012 37 patients with PSC were detected and analyzed. 24/37 (65%) patients presented a concomitant UC diagnosis. Comparing the two subgroups (PSC and UC with PSC only) a significative difference in age at PSC diagnosis was found (p = 0.027). The mean age at the time of PSC diagnosis was 55.3 in PSC only group vs 39.8 in PSC-UC subgroup.

Regarding of the clinical and histological features of UC we have obtained the data presented in the table.

Dysplasia developed in 5/24 individuals (22%): a right sided colon cancer, two DALMs lesions and two dysplastic adenomatous polyps. One case of cholangiocarcinoma was observed in this series. In our series 24.3% of patients (9/37) had concomitant autoimmune disorders.

Table: Data for patients presenting a concomitant UC diagnosis (N = 24)
Age at UC diagnosis, years (mean±SD)§35.3±14.0
UC duration, years [median (range)]§10 (1–30)
PSC+UC duration, years [median (range)]§7 (1–23)
Pancolitis at diagnosis n (%)24 (100%)
Episodes of patchy inflammation proximal to the rectum n (%)*10 (66.7%)
Episodes of rectal sparing on any examination n (%)#10 (58.8%)
Overall grading colitis, mean±SD1.8±0.7
BWI on any examination n (%)°8 (57.14%)
§Diagnosis date available in 22 pts. *Data not available in 9 pts. #Data not available in 7 pts. °Data not available in 10 pts.

Conclusion

UC patients with PSC are more likely to have a mild pancolitis with rectal sparing and patchy inflammation. Our findings are in keeping with previous studies in describing a distinct UC phenotype in patients with PSC.