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P196 Patients with ulcerative colitis (UC) and concomitant primary sclerosing cholangitis (PSC) have more subclinical endoscopic and histologic disease activity in the right colon compared to UC patients without PSC

Krugliak Cleveland N.1, Rubin D.1, Meckel K.1, Tran A.1, Aelvoet A.1, Gonsalves A.1, Gaetano J.N.2, Williams K.1, Jabri B.1, Wroblewski K.3, Pekow J.*1

1University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, United States 2Northwestern University Feinberg School of Medicine, Chicago, United States 3University of Chicago, Department of Public Health Science, Chicago, United States


Primary sclerosing cholangitis (PSC) is an independent risk factor for colorectal cancer (CRC) in ulcerative colitis (UC) patients (pts), however the reason for this is not known. We hypothesized that patients with UC and concomitant PSC (UC-PSC) may have more active subclinical disease than patients with UC alone.


This is a retrospective case control study of pts with UC-PSC (cases) and UC without PSC (controls). Included pts had pancolitis and were in clinical remission (defined as Simple Clinical Colitis Activity Index score ≤2) within 3 months of a colonoscopy. Colonoscopy, pathology and clinical data from 2011–2016 were reviewed. Disease activity was scored using a modified Mayo score for 3 segments: right colon, left colon, and rectum. Histologic scores were translated from pathology reports as quiescent, mild, moderate or severe. We dichotomized results to quiescent and active disease, and compared degree of endoscopic and histologic activity by segment between cases and controls using univariate and multivariate generalized estimating equation (GEE) logistic regression models. We also assessed concordance between endoscopic and histologic scores.


143 patients (23 UC-PSC; 120 UC) with 205 exams (36 UC-PSC; 169 UC) were included. Cases and controls were similar except that cases were younger at first colonoscopy and more often males.

Table 1. Demographics of cases (PSC-UC) and controls (UC)

PSC-UC n=23UC n=120p value
Age at first colonoscopy (Mean (SD))38.1 (13.7)46.4 (16.8)0.01
Female gender6 (26.1%)52 (43.3%)0.12
White19 (82.6%)93 (79.5%)0.73
Ever used anti-TNF8 (34.8%)36 (30.0%)0.65
Ever used IMM13 (56.5%)59 (49.2%)0.52
Ever used steroids5 (21.7%)26 (21.7%)0.99
Ever used 5-ASA13 (56.5%)70 (58.3%)0.87
Ever used vedolizumab3 (13.0%)7 (5.8%)0.21

Cases had significantly more endoscopic activity (OR=4.12, 95% CI 1.67–10.20, p=0.002) and more histologic activity (OR=5.13, 95% CI 2.25–11.68, p<0.001) in the right colon compared to controls, which remained significant after adjusting for gender, age at colonoscopy, steroid use and race. Cases also had significantly greater odds of worse histologic vs. endoscopic inflammation of the right colon compared to controls (OR =3.14, 95% CI 1.24–7.97, p=0.02). In contrast, cases had significantly less histologic activity than controls in the rectum on multivariate analysis (OR=0.24, 95% CI 0.08–0.72, p=0.01).

Table 2. Multivariate analysis of cases (PSC-UC) compared to controls (UC) adjusting for gender, steroid exposure, race and age at first colonoscopy

OR (95% CI)p value
Right colon
 Endoscopic activity4.21 (1.67–10.63)0.002
 Histologic activity4.87 (2.04–11.61)<0.001
Left colon
 Endoscopic activity1.54 (0.61–3.90)0.36
 Histologic activity1.51 (0.62–3.68)0.37
 Endoscopic activity0.80 (0.33–1.96)0.63
 Histologic activity0.24 (0.08–0.72)0.01


UC patients with PSC in clinical remission have more frequent and severe histologic and endoscopic disease activity of the right colon compared to UC patients without PSC. We believe that these findings provide insight into the increased cancer risk of PSC patients, and warrant more careful right-sided disease activity monitoring in these at-risk patients.