The Phenotypic Expression of Inflammatory Bowel Disease in Patients with Primary Sclerosing Cholangitis Differs in the D
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ORIGINAL ARTICLE
The Phenotypic Expression of Inflammatory Bowel Disease in Patients with Primary Sclerosing Cholangitis Differs in the Distribution of Colitis David F. Schaeffer • Lay Lay Win • Sara Hafezi-Bakhtiari • Maria Cino • Gideon M. Hirschfield • Hala El-Zimaity
Received: 23 November 2012 / Accepted: 18 April 2013 / Published online: 14 May 2013 Ó Springer Science+Business Media New York 2013
Abstract Background Inflammatory bowel disease (IBD) associated with primary sclerosing cholangitis (PSC) is reported to be mild and prone to right-side predominance with rectal sparing. However, no dedicated studies evaluating patterns of presentation of liver disease with respect to IBD are available. Methods We performed a detailed histological examination of the colonic biopsies in the context of PSC, identifying 97 patients [89 with ulcerative colitis and ten with Crohn’s disease (CD)] stratified into two groups, based on their initial disease presentation: hepatic/biliary (group 1— PSC-IBD; n = 56) versus colonic (group 2—IBD-PSC; n = 41). Results Inflammatory bowel disease that preceded PSC had a tendency to have a ‘‘pan-colitis’’ distribution; this group included all patients with CD. Inflammatory bowel disease diagnosis that followed PSC presentation was more likely to be right-sided, sparing the descending, sigmoid and rectal regions (p = 0.002). In both groups, colitis was
D. F. Schaeffer S. Hafezi-Bakhtiari H. El-Zimaity (&) Department of Laboratory Medicine and Pathology, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada e-mail: [email protected] L. L. Win M. Cino Liver Centre, Toronto Western Hospital, Toronto, ON, Canada M. Cino G. M. Hirschfield Division of Medicine, University of Toronto, Toronto, ON, Canada G. M. Hirschfield Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham, UK
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mild with focal deep plasmacytosis and occasional mild cryptitis. Active cryptitis with crypt abscesses, surface erosion and ulceration were not identified in any of the patients. Conclusion Colitis associated with PSC shows mild disease activity and the colitis pattern is associated with disease presentation, i.e. colitis preceding PSC (IBD-PSC cohort) typically have a pancolitic distribution, while colitis following PSC (PSC-IBD cohort) demonstrates right-sided predominance. Awareness by pathologists and clinicians of these patterns of inflammatory bowel disease is important and of use in directing appropriate investigations for patients. Keywords Ulcerative colitis Inflammatory bowel disease Primary sclerosing cholangitis Pancolitis PSC-IBD Colitis distribution
Introduction The association of primary sclerosing cholangitis (PSC) with ulcerative colitis (UC) is long described [1]. An association with Crohn’s disease (CD) was also suggested early on, but was found to be less common than with UC [2]. More recent studies have proposed consideration of PSC-IBD as a third IBD phenotype, independent of UC a
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