DOP065. Autoimmune sclerosing cholangitis is associated with small bowel ulceration on capsule enteroscopy
B. Hayee1, M. Samyn2, D. Shawcross3, M. Heneghan3, I. Bjarnason1, 1King's College Hospital NHS Foundation Trust, Gastroenterology, London, United Kingdom, 2King's College Hospital NHS Foundation Trust, Paediatric Hepatology, London, United Kingdom, 3King's College Hospital NHS Foundation Trust, Insitute of Hepatology, London, United Kingdom
Patients with primary (PSC) and autoimmune sclerosing cholangitis (AISC) frequently have colonic inflammation classified as ulcerative colitis. However this differs from ‘classic’ ulcerative colitis in that it is often associated with rectal sparing, a very mild clinical course is typical yet the prevalence of colon cancer, and of pouchitis after colectomy, is higher. We assessed colonoscopy, faecal calprotectin (FC) and capsule enteroscopy (CE) findings in these patients.
18 patients with AISC and 16 with PSC - all with clinically quiescent colitis were identified from a Transition IBD clinic. A further 5 and 6 such patients without colitis, respectively, were included. Liver disease had been diagnosed based on positive anti-nuclear or anti-smooth muscle antibodies, characteristic ERCP or MRCP findings and liver biopsy. All patients had undergone CE and at least one sample for FC in the 3 months prior to analysis.
The colitis of PSC and AISC did not differ macro- or microscopically and was described as predominantly right-sided involvement with variable rectal sparing, but otherwise consistent with ulcerative colitis. At the time of testing, although clinically quiescent, all but one patient each with PSC- and ASC-colitis had elevated FC with a mean of 601 (107–999mcg/g) and 627 (115–1744 mcg/g), respectively (normal <60 mcg/g). 7/18 ASC had small bowel lesions at CE, compared to 0/16 with PSC (p = 0.008). All the patients without colitis had normal findings.
Despite clinical quiescence of colitis, patients with PSC and AISC have significant inflammatory activity assessed by FC. The colonoscopic and histopathological features resembled ulcerative colitis as previously described, but many patients with AISC had small bowel lesions. This is the first description of small bowel ulceration in patients with AISC and may represent a new category of inflammatory bowel disease.