Primary Sclerosing Cholangitis with Inflammatory Bowel Disease in Korean Children

Abstract

Purpose: Primary sclerosing cholangitis (PSC) is a rare condition that can be associated with inflammatory bowel disease (IBD). The aim of this study was to evaluate PSC and its association with IBD in children.

Methods: We retrospectively enrolled 13 pediatric patients (<18 years) with PSC treated at Asan Medical Center between June 1989 and December 2013. Clinical findings and long-term outcomes were investigated. During the same period, the incidence of PSC among IBD patients was evaluated among 600 Crohn disease (CD) and 210 ulcerative colitis (UC) patients.

Results: All 13 study patients diagnosed with PSC also presented with IBD. Eleven boys and two girls with a median age of 15.0 years old (9.0-17.8 years) were included. The cumulative incidence of PSC for UC was 5.7% (12 of 210) and 0.2% for CD (1 of 600), respectively. PSC occurred during follow-up for IBD for five patients (38.5%) whereas, IBD developed during follow-up for PSC for two patients (15.4%), and was diagnosed during the initial work-up for PSC for 6 patients (46.2%). For the 77.3 month median follow-up period, 9/13 patients (69.2%), neither the clinical symptoms nor blood test results worsened. Two cases (15.4%) developed liver cirrhosis and underwent liver transplantation. Among 13 PSC patients with IBD, two (15.4%) developed colorectal cancer, and no one developed cholangiocarcinoma.

Conclusion: All patients with PSC in this study had associated IBD. The incidence of PSC was not rare compared to reports in adults. PSC should be considered during the management of IBD and vice versa in children.

Keywords: Colorectal neoplasms; Crohn disease; Inflammatory bowel diseases; Liver transplantation; Sclerosing cholangitis; Ulcerative colitis.

Fig. 1. (A) Endoscopic retrograde cholangiopancreatography (ERCP) showing focal dilatation and narrowing of the intrahepatic and extrahepatic bile ducts. (B) ERCP showing focal dilatation and narrowing of the intrahepatic bile ducts. (C) Magnetic resonance cholangiopancreatography revealing irregular dilatation and narrowing and beaded appearance of the intrahepatic bile duct.

Fig. 2. Microscopic findings showing onion-skin type periductal fibrosis and mild lymphocytic infiltration around the interlobular bile ducts (H&E stain, ×100).