Skip to main content
Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences 2/2011

01.03.2011 | Original article

Clinical characteristics of inflammatory bowel disease associated with primary sclerosing cholangitis

verfasst von: Hitoshi Sano, Takahiro Nakazawa, Tomoaki Ando, Kazuki Hayashi, Itaru Naitoh, Fumihiro Okumura, Katsuyuki Miyabe, Michihiro Yoshida, Satoru Takahashi, Hirotaka Ohara, Takashi Joh

Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences | Ausgabe 2/2011

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Only a few studies have documented the characteristics of inflammatory bowel disease (IBD) associated with primary sclerosing cholangitis (PSC). We aimed to clarify the clinical and histopathological characteristics of IBD associated with PSC (PSC-IBD).

Methods

Twenty-nine patients with PSC and 60 patients with ulcerative colitis (UC) but without complicating PSC were enrolled in this study. First, the age and sex distribution, affected area, clinical course, number of recurrent attacks, and severity of UC were investigated. Then, mucosal specimens obtained from the right side (cecum and ascending colon), transverse colon, and the left side (descending colon, sigmoid colon, and rectum) during colonoscopy were studied for inflammatory cell infiltration, the presence of crypt abscesses, the degree of goblet cell disappearance, and edema.

Results

(1) The incidence of IBD in PSC patients was 68.9% (20/29). There were two peaks in the age distribution of PSC. Male PSC patients demonstrated a first peak and female patients a second peak. Male PSC-IBD patients were in their teens and 20s making the first peak. Female PSC-IBD patients were in their 50s and 60s making the second peak. The PSC-IBD patents were significantly younger than the patients without IBD (33.6 vs. 58.9 years, p < 0.001). (2) PSC-IBD showed a right-sided predominance colonoscopically. (3) None of the patients had a severe clinical course, and a half of them were asymptomatic. (4) Histopathological examination demonstrated severe inflammatory cell infiltration in the cecum and ascending colon, whereas the degree was mild in the rectum/descending colon.

Conclusions

PSC-IBD shows characteristic clinical, colonoscopic, and histopathological findings.
Literatur
1.
Zurück zum Zitat Vierling JM. In: Manns P, Chapman RW, Stiehl A, et al., editors. Primary sclerosing cholangitis. London: Kluwer; 1988. p. 37–45. Vierling JM. In: Manns P, Chapman RW, Stiehl A, et al., editors. Primary sclerosing cholangitis. London: Kluwer; 1988. p. 37–45.
2.
Zurück zum Zitat Lazaridis KN, Wiesner RH, Porayko MK, Ludwig J, LaRusso NF. Primary sclerosing cholangitis. In: Schiff ER, Sorrel MF, Maddrey WC, editors. Schiff’s disease of the liver. English Edition. Philadelphia: Lippincott-Raven; 1999. p. 649–78. Lazaridis KN, Wiesner RH, Porayko MK, Ludwig J, LaRusso NF. Primary sclerosing cholangitis. In: Schiff ER, Sorrel MF, Maddrey WC, editors. Schiff’s disease of the liver. English Edition. Philadelphia: Lippincott-Raven; 1999. p. 649–78.
3.
Zurück zum Zitat Lindor KD, LaRusso NF. Primary sclerosing cholangitis. In: Schiff L, Schiff ER, editors. Schiff’s disease of the liver, Nineth edition. Philadelphia: JB Lippincott; 2003. p. 673–84. Lindor KD, LaRusso NF. Primary sclerosing cholangitis. In: Schiff L, Schiff ER, editors. Schiff’s disease of the liver, Nineth edition. Philadelphia: JB Lippincott; 2003. p. 673–84.
4.
Zurück zum Zitat Wiesner RH, Grambsch PM, Dickson ER, Ludwig J, MacCarty RL, Hunter EB, et al. Primary sclerosing cholangitis: natural history, prognostic factors and survival analysis. Hepatology 1989;430–36. Wiesner RH, Grambsch PM, Dickson ER, Ludwig J, MacCarty RL, Hunter EB, et al. Primary sclerosing cholangitis: natural history, prognostic factors and survival analysis. Hepatology 1989;430–36.
5.
Zurück zum Zitat Takikawa H, Manabe T. Primary sclerosing cholangitis in Japan—analysis of 192 cases. J Gastroenterol. 1997;32:134–7.PubMedCrossRef Takikawa H, Manabe T. Primary sclerosing cholangitis in Japan—analysis of 192 cases. J Gastroenterol. 1997;32:134–7.PubMedCrossRef
6.
Zurück zum Zitat Takikawa H, Takamori Y, Tanaka A, Kurihara H, Nakanuma Y. Analysis of 388 cases of primary sclerosing cholangitis in Japan. Presence of a subgroup without pancreatic involvement in older patients. Hepatol Res. 2004;29:153–9.PubMedCrossRef Takikawa H, Takamori Y, Tanaka A, Kurihara H, Nakanuma Y. Analysis of 388 cases of primary sclerosing cholangitis in Japan. Presence of a subgroup without pancreatic involvement in older patients. Hepatol Res. 2004;29:153–9.PubMedCrossRef
7.
Zurück zum Zitat Loftus EV, Harewood GC, Loftus CG, Tremaine WJ, Harmsen WS, Zinsmeister AR, et al. PSC–IBD: a unique form of inflammatory bowel disease associated with primary sclerosing cholangitis. Gut. 2005;54:91–6.PubMedCrossRef Loftus EV, Harewood GC, Loftus CG, Tremaine WJ, Harmsen WS, Zinsmeister AR, et al. PSC–IBD: a unique form of inflammatory bowel disease associated with primary sclerosing cholangitis. Gut. 2005;54:91–6.PubMedCrossRef
8.
Zurück zum Zitat Sokol H, Cosnes J, Chazouilleres O, Beaugerie L, Tiret E, Poupon R, et al. Disease activity and cancer risk in inflammatory bowel disease associated with primary sclerosing cholangitis. World J Gastroenterol. 2008;14:3497–503.PubMedCrossRef Sokol H, Cosnes J, Chazouilleres O, Beaugerie L, Tiret E, Poupon R, et al. Disease activity and cancer risk in inflammatory bowel disease associated with primary sclerosing cholangitis. World J Gastroenterol. 2008;14:3497–503.PubMedCrossRef
9.
Zurück zum Zitat Uchida N, Ezaki T, Fukuma H, Tsutsui K, Kobara H, Matsuoka M, et al. Concomitant colitis associated with primary sclerosing cholangitis. J Gastroenterol. 2003;38:482–7.PubMedCrossRef Uchida N, Ezaki T, Fukuma H, Tsutsui K, Kobara H, Matsuoka M, et al. Concomitant colitis associated with primary sclerosing cholangitis. J Gastroenterol. 2003;38:482–7.PubMedCrossRef
10.
Zurück zum Zitat Oshitani N, Jinno Y, Sawa Y, Nakamura S, Matsumoto T, Nishiguchi S, et al. Does colitis associated with primary sclerosing cholangitis represent an actual subset of ulcerative colitis? Hepatogastroenterology. 2003;50:1830–5.PubMed Oshitani N, Jinno Y, Sawa Y, Nakamura S, Matsumoto T, Nishiguchi S, et al. Does colitis associated with primary sclerosing cholangitis represent an actual subset of ulcerative colitis? Hepatogastroenterology. 2003;50:1830–5.PubMed
11.
Zurück zum Zitat Yamagishi N, Iizuka B. Ulcerative colitis and primary sclerosing cholangitis: colonoscopic features of concomitant colitis with primary sclerosing cholangitis (in Japanese). Kan Tan Sui. 2004;49:221–8. Yamagishi N, Iizuka B. Ulcerative colitis and primary sclerosing cholangitis: colonoscopic features of concomitant colitis with primary sclerosing cholangitis (in Japanese). Kan Tan Sui. 2004;49:221–8.
12.
Zurück zum Zitat Tanaka M, Riddell RH. The pathological diagnosis and differential diagnosis of Crohn’s disease. Hepatogastroenterology. 1990;27:18–31. Tanaka M, Riddell RH. The pathological diagnosis and differential diagnosis of Crohn’s disease. Hepatogastroenterology. 1990;27:18–31.
13.
Zurück zum Zitat Price AB. Overlap in the spectrum of non-specific inflammatory bowel disease-“colitis indeterminate”. J Clin Pathol. 1978;31:567–77.PubMedCrossRef Price AB. Overlap in the spectrum of non-specific inflammatory bowel disease-“colitis indeterminate”. J Clin Pathol. 1978;31:567–77.PubMedCrossRef
14.
Zurück zum Zitat Lee KS, Medline A, Shockey S. Indeterminate colitis in the spectrum of inflammatory bowel disease. Arch Pathol Lab Med. 1979;103:173–6.PubMed Lee KS, Medline A, Shockey S. Indeterminate colitis in the spectrum of inflammatory bowel disease. Arch Pathol Lab Med. 1979;103:173–6.PubMed
15.
Zurück zum Zitat Matsui T, Yao T, Sakurai T, Yao K, Hirai F, Matake H, et al. Clinical features and pattern of indeterminate colitis: Crohn’s disease with ulcerative colitis-like clinical presentation. J Gastroenterol. 2003;38:647–55.PubMedCrossRef Matsui T, Yao T, Sakurai T, Yao K, Hirai F, Matake H, et al. Clinical features and pattern of indeterminate colitis: Crohn’s disease with ulcerative colitis-like clinical presentation. J Gastroenterol. 2003;38:647–55.PubMedCrossRef
16.
Zurück zum Zitat Hiwatashi N. Criteria for diagnosis of ulcerative colitis (preliminary proposal). In: Muto T, editor. Annual report of the Research Committee of Inflammatory Bowel Disease. Tokyo: Ministry of Health and Welfare of Japan; 1993. p. 90–2. Hiwatashi N. Criteria for diagnosis of ulcerative colitis (preliminary proposal). In: Muto T, editor. Annual report of the Research Committee of Inflammatory Bowel Disease. Tokyo: Ministry of Health and Welfare of Japan; 1993. p. 90–2.
17.
Zurück zum Zitat Gilaad GK, Kevin BL, Decker B, Stefan JU, Samuel SL. The burden of large and small duct primary sclerosing cholangitis in adults and children: a population-based analysis. Am J Gastroenterol. 2007;102:1042–9.CrossRef Gilaad GK, Kevin BL, Decker B, Stefan JU, Samuel SL. The burden of large and small duct primary sclerosing cholangitis in adults and children: a population-based analysis. Am J Gastroenterol. 2007;102:1042–9.CrossRef
18.
Zurück zum Zitat Nakazawa T, Ohara H, Sano H, Ando T, Aoki S, Kobayashi S, et al. Clinical differences between primary sclerosing cholangitis and sclerosing cholangitis with autoimmune pancreatitis. Pancreas. 2005;30:20–5.PubMed Nakazawa T, Ohara H, Sano H, Ando T, Aoki S, Kobayashi S, et al. Clinical differences between primary sclerosing cholangitis and sclerosing cholangitis with autoimmune pancreatitis. Pancreas. 2005;30:20–5.PubMed
19.
Zurück zum Zitat Nakazawa T, Ohara H, Sano H, Aoki S, Kobayashi S, Okamoto T, et al. Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholantis. Gastrointest Endosc. 2004;60:937–44.PubMedCrossRef Nakazawa T, Ohara H, Sano H, Aoki S, Kobayashi S, Okamoto T, et al. Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholantis. Gastrointest Endosc. 2004;60:937–44.PubMedCrossRef
20.
Zurück zum Zitat Utsunomiya T, Katsumata T, Nakayama T, Kitahora T, Ohara S, Yokota H, et al. Prevalence of ulcerative colitis (1973–1991). In: Muto T, editor. Annual report of the Research Committee of Inflammatory Bowel Disease. Tokyo: Ministry of Health and Welfare of Japan; 1993. p. 274–8. Utsunomiya T, Katsumata T, Nakayama T, Kitahora T, Ohara S, Yokota H, et al. Prevalence of ulcerative colitis (1973–1991). In: Muto T, editor. Annual report of the Research Committee of Inflammatory Bowel Disease. Tokyo: Ministry of Health and Welfare of Japan; 1993. p. 274–8.
21.
Zurück zum Zitat Bentley DW, Nicholos RL, Condon RE, Gorbach SL. The microflora of the human ileum and intra-abdominal colon: results of direct needle aspiration at surgery and evaluation of the technique. J Lab Clin Med. 1972;79:421–9.PubMed Bentley DW, Nicholos RL, Condon RE, Gorbach SL. The microflora of the human ileum and intra-abdominal colon: results of direct needle aspiration at surgery and evaluation of the technique. J Lab Clin Med. 1972;79:421–9.PubMed
22.
Zurück zum Zitat Evans DF, Pye G, Bramley R, Clark AG, Dyson TJ, Hardcastle JD. Measurement of gastrointestinal PH profiles in normal ambulant human subjects. Gut. 1988;29:1035–41.PubMedCrossRef Evans DF, Pye G, Bramley R, Clark AG, Dyson TJ, Hardcastle JD. Measurement of gastrointestinal PH profiles in normal ambulant human subjects. Gut. 1988;29:1035–41.PubMedCrossRef
23.
Zurück zum Zitat Nair PP, Gordon M, Reback J. The enzymatic cleavage of the carbon-nitrogen bond in 3a, 7a, 12a-trihydroxy-5b-cholan-24-oyl glycine. J Biol Chem. 1967;243:7–11. Nair PP, Gordon M, Reback J. The enzymatic cleavage of the carbon-nitrogen bond in 3a, 7a, 12a-trihydroxy-5b-cholan-24-oyl glycine. J Biol Chem. 1967;243:7–11.
24.
Zurück zum Zitat Stellwag EJ, Hylemon PB. 7a Dehydroxylation of cholic acid and chenodeoxycholic acid by Clostridium leptum. J Lipid Res. 1979;20:325–33.PubMed Stellwag EJ, Hylemon PB. 7a Dehydroxylation of cholic acid and chenodeoxycholic acid by Clostridium leptum. J Lipid Res. 1979;20:325–33.PubMed
25.
Zurück zum Zitat Thomas LA, Veysey MJ, French G, Hylemon PB, Murphy GM, Dowling RH. Bile acid metabolism by fresh human colonic contents: a comparison of caecal versus faecal samples. Gut. 2001;49:835–42.PubMedCrossRef Thomas LA, Veysey MJ, French G, Hylemon PB, Murphy GM, Dowling RH. Bile acid metabolism by fresh human colonic contents: a comparison of caecal versus faecal samples. Gut. 2001;49:835–42.PubMedCrossRef
26.
27.
Zurück zum Zitat Yamada S, Ishii M, Liang LS, Yamamoto T, Toyota T. Small duct cholangitis induced by N-formyl l-methionine l-leucine l-tyrosine in rats. J Gastroenterol. 1994;29:631–6.PubMedCrossRef Yamada S, Ishii M, Liang LS, Yamamoto T, Toyota T. Small duct cholangitis induced by N-formyl l-methionine l-leucine l-tyrosine in rats. J Gastroenterol. 1994;29:631–6.PubMedCrossRef
28.
Zurück zum Zitat Morita N, Furuno S, Siraki K, Sawada T, Muto T, Tamakosi A, et al. Nationwide epidemiological survey of IBD. In: Muto T, editor. Annual report of the Research Committee of Inflammatory Bowel Disease. Tokyo: Ministry of Health and Welfare of Japan; 1994. p. 176–83. Morita N, Furuno S, Siraki K, Sawada T, Muto T, Tamakosi A, et al. Nationwide epidemiological survey of IBD. In: Muto T, editor. Annual report of the Research Committee of Inflammatory Bowel Disease. Tokyo: Ministry of Health and Welfare of Japan; 1994. p. 176–83.
29.
Zurück zum Zitat Shetty K, Rybicki L, Brzezinski A, Carey WD, Lashner BA. The risk for cancer or dysplasia in ulcerative colitis patients with primary sclerosing cholangitis. Am J Gastroenterol. 1999;94:1643–9.PubMedCrossRef Shetty K, Rybicki L, Brzezinski A, Carey WD, Lashner BA. The risk for cancer or dysplasia in ulcerative colitis patients with primary sclerosing cholangitis. Am J Gastroenterol. 1999;94:1643–9.PubMedCrossRef
30.
Zurück zum Zitat Brentnall TA. Risk and natural history of colonic neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis. Gastroenterology. 1996;110:331–8.PubMedCrossRef Brentnall TA. Risk and natural history of colonic neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis. Gastroenterology. 1996;110:331–8.PubMedCrossRef
31.
Zurück zum Zitat Rosen CB, Nagorney DM, Wiesner RH, Coffey RJ Jr, LaRusso NF, et al. Cholangiocarcinoma complicating primary sclerosing cholangitis. Ann Surg. 1991;213:21–5.PubMedCrossRef Rosen CB, Nagorney DM, Wiesner RH, Coffey RJ Jr, LaRusso NF, et al. Cholangiocarcinoma complicating primary sclerosing cholangitis. Ann Surg. 1991;213:21–5.PubMedCrossRef
Metadaten
Titel
Clinical characteristics of inflammatory bowel disease associated with primary sclerosing cholangitis
verfasst von
Hitoshi Sano
Takahiro Nakazawa
Tomoaki Ando
Kazuki Hayashi
Itaru Naitoh
Fumihiro Okumura
Katsuyuki Miyabe
Michihiro Yoshida
Satoru Takahashi
Hirotaka Ohara
Takashi Joh
Publikationsdatum
01.03.2011
Verlag
Springer Japan
Erschienen in
Journal of Hepato-Biliary-Pancreatic Sciences / Ausgabe 2/2011
Print ISSN: 1868-6974
Elektronische ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-010-0319-8

Weitere Artikel der Ausgabe 2/2011

Journal of Hepato-Biliary-Pancreatic Sciences 2/2011 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.