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. 2025 Sep 24.
doi: 10.1097/MCG.0000000000002253. Online ahead of print.

Clinical and Prognostic Factors Associated With Inflammatory Bowel Disease in a Highly Admixed Population With Primary Sclerosing Cholangitis

Mateus Jorge Nardelli  1 , Guilherme Grossi Lopes Cançado  1 , Luísa Leite Barros  2 , Diogo Delgado Dotta  2 , Luciana Costa Faria  1 , Vivian Rotman  3 , Cristiane Alves Villela-Nogueira  3 , Maria Lucia Gomes Ferraz  4 , Rodrigo Rocco  5 , Guilherme Eduardo Felga  5 , Adrielly de Souza Martins  6 , Liana Codes  7 , Liliana Sampaio Costa Mendes  8 , Marlone Cunha da Silva  9 , Elodie Bonfim Hyppolito  10 , Geisa Perez Medina Gomide  11 , Izabelle Venturini Signorelli  12 , Maria Beatriz de Oliveira  13 , Claudia Alexandra Pontes Ivantes  14 , Maria Chiara  15 , Valéria Ferreira de Almeida E Borges  16 , Débora Raquel Benedita Terrabuio  2 , Eduardo Luiz Rachid Cançado  2 , Paulo Lisboa Bittencourt  7 , Claudia Alves Couto  1
Affiliations

Clinical and Prognostic Factors Associated With Inflammatory Bowel Disease in a Highly Admixed Population With Primary Sclerosing Cholangitis

Mateus Jorge Nardelli et al. J Clin Gastroenterol. .

Abstract

Goals: To investigate the prevalence of inflammatory bowel disease (IBD) in a cohort of Brazilian patients with primary sclerosing cholangitis (PSC) and evaluate clinical and prognostic factors associated with concomitant IBD.

Background: IBD is reported worldwide in 62% to 81% of patients with PSC, especially in males and north Europeans. Little is known about the association of IBD and PSC in population from multigenetic ethnic origin.

Study: Data of PSC patients from the Brazilian Cholestasis Study Group database were retrospectively reviewed to compare demographic, clinical, laboratory, and transplant-free survival between those with and without IBD.

Results: After exclusion of 59 (14%) participants with overlap syndrome with autoimmune hepatitis, 359 individuals with PSC were included {56% male, median age 44 [interquartile range (IQR): 33 to 54] y}. IBD was investigated in 298 (83%) participants and diagnosed in 217 (73%), including ulcerative colitis (83%), Crohn's disease (13%), and indeterminate colitis (4%). Male sex frequency was similar in patients with and without IBD (58% vs. 47%, P=0.073). IBD was more frequently diagnosed in patients without obesity (P=0.035), positive for antinuclear antibody (P=0.006), and positive for anti-smooth muscle antibody (P=0.046). IBD diagnosis occurred before, concomitant, or after PSC diagnosis in 59%, 22%, and 19% of cases, respectively. IBD was more frequently diagnosed before PSC in participants asymptomatic for liver disease (P=0.017), without advanced liver disease (P=0.017), before liver transplantation (LT) (P<0.001), and positive for antinuclear antibody (P=0.021). In a median follow-up of 69 months (IQR 31-124), LT occurred in 27.7% and cohort mortality was 11.4%. IBD was neither associated with the combined outcome of death or LT (P=0.745) nor with transplant-free survival (P=0.902).

Conclusions: In Brazilian PSC patients, IBD frequency was similar to that reported in other populations but exhibited a balanced proportion between males and females. IBD diagnosis occurred before PSC in most patients, especially those without advanced liver disease. IBD presence was not associated with worse PSC prognosis.

Keywords: Brazil; Crohn’s disease; epidemiology; ethnic origin; primary sclerosing cholangitis; ulcerative colitis.

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