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. 2025 Dec 1:S1542-3565(25)01004-3.
doi: 10.1016/j.cgh.2025.11.020. Online ahead of print.

Prevalence and Outcomes of Primary Sclerosing Cholangitis in Inflammatory Bowel Disease: A Multinational Study Across Asia

Shintaro Akiyama  1 , Sang Hyoung Park  2 , Ji Eun Baek  3 , Sachiko Kanai  4 , Naminatsu Takahara  5 , Ryosuke Kasuga  5 , Nobuhiro Nakamoto  5 , Yasuhiro Takagi  6 , Shinichiro Shinzaki  6 , Meng-Tzu Weng  7 , Shu-Chen Wei  7 , Toshio Fujisawa  8 , Hiroyuki Isayama  8 , Sidharth Harindranath  9 , Devendra Desai  9 , Jie Liang  10 , Daye Park  11 , Soo Jung Park  11 , Suguru Mizuno  12 , Satoshi Mochida  12 , Karen Hei-Tung Lai  13 , Joyce Wing Yan Mak  13 , Xin-Hui Khoo  14 , Ida Hilmi  14 , Naoki Ishikawa  15 , Yu Bei Gu  16 , Hu Zhang  17 , Shin Ju Oh  18 , Yasuki Sano  19 , Yusuke Honzawa  19 , Tsz-Fai Cheng  20 , Katsuyoshi Matsuoka  21 , Dong Hyun Kim  22 , Takeshi Fujima  23 , Minoru Matsuura  23 , Kyeong Ok Kim  24 , Byung Ik Jang  24 , Hsu-Heng Yen  25 , Sung-Ae Jung  26 , To-Lam Suen  27 , Yen-Hsuan Ni  28 , Makoto Naganuma  19
Affiliations
Free article

Prevalence and Outcomes of Primary Sclerosing Cholangitis in Inflammatory Bowel Disease: A Multinational Study Across Asia

Shintaro Akiyama et al. Clin Gastroenterol Hepatol. .
Free article

Abstract

Background & aims: Primary sclerosing cholangitis (PSC) frequently coexists with inflammatory bowel disease (IBD). PSC is a progressive disease that may lead to end-stage liver failure requiring liver transplantation (LT). Although PSC-IBD has been extensively studied in Western populations, data from Asia remain limited. We conducted an international multicenter study across Asia to investigate the prevalence of PSC in IBD patients and evaluate its impact on clinical outcomes.

Methods: This retrospective cohort study included patients with IBD from 25 hospitals in 6 Asian countries. The primary endpoint was the prevalence of PSC in patients with IBD. The secondary endpoints included the incidence of colorectal neoplasia and IBD-related surgery following IBD diagnosis, and the occurrence of cholangiocarcinoma, LT, and death after PSC diagnosis among patients with PSC-IBD. Temporal trends were assessed across 5 diagnostic eras of PSC.

Results: Among 51,314 patients with IBD, 474 had PSC (0.92%), with a prevalence of 1.4% in ulcerative colitis and 0.13% in Crohn's disease. Among 375 Asian patients with PSC-IBD, 9.1% developed colorectal neoplasia, 7.2% developed cholangiocarcinoma, 24% underwent LT, and 16% died. In more recent diagnostic eras, patients presented with fewer symptoms, lower alkaline phosphatase levels, and better liver function scores. The use of magnetic resonance cholangiopancreatography has increased over time. Symptomatic PSC and low serum albumin were significantly associated with a shorter time to LT, which was significantly longer in recent eras (P = .016).

Conclusions: PSC is less prevalent among Asian patients with IBD than in Western populations. The increased use of magnetic resonance cholangiopancreatography may enable earlier detection, contributing to milder disease severity and improved clinical outcomes in recent years.

Keywords: Asia; Epidemiology; Inflammatory Bowel Disease; Primary Sclerosing Cholangitis.

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