Concurrent inflammatory bowel disease and primary sclerosing cholangitis: a review of pre- and post-transplant outcomes and treatment options
Gastroenterology and Hepatology from Bed to Bench,
Vol. 16 No. 3 (2023),
3 June 2023
https://doi.org/10.22037/ghfbb.v16i2.2589
Abstract
Primary Sclerosing Cholangitis (PSC) is a chronic cholestatic liver disease which is associated with Inflammatory Bowel Disease (IBD) in 70% of cases. It seems PSC/IBD is a distinct phenotype that is different from PSC, and IBD alone. Hence, we review the epidemiology, pathogenesis, natural course and management of PSC/IBD before and after LT for PSC. Extensive colitis, rectal sparing, backwash ileitis, and mild symptoms are the characteristics of IBD coexisting with PSC. Moreover, PSC patients with concurrent IBD have higher risk of cholangiocarcinoma, and colorectal neoplasia predominantly in right colon and at younger age. Therefore, it is essential to monitor these individuals continuously. It is interesting to note that the course of IBD (ulcerative colitis) after liver transplantation (LT) for PSC varies greatly, and some patients may develop worsening colitis after LT despite immunosuppressive regimens. As well, management of these patients was discussed in this review.
Keywords:
- Primary sclerosing cholangitis; Inflammatory bowel disease; Liver transplantation; Cholangiocarcinoma; Colorectal neoplasia
How to Cite
Hatami, B., Pasharavesh, L. ., sharifian, A., & Zali, M. R. (2023). Concurrent inflammatory bowel disease and primary sclerosing cholangitis: a review of pre- and post-transplant outcomes and treatment options. Gastroenterology and Hepatology from Bed to Bench, 16(3). https://doi.org/10.22037/ghfbb.v16i2.2589
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6. Mumtaz S, Goh J, Hirschfield GM, Ferguson J, Cooper SC. Evolving strategies to reduce colectomy rates in primary sclerosing cholangitis-inflammatory bowel disease: clinical remission of corticosteroid refractory colitis post-liver transplant with vedolizumab. Frontline gastroenterology. 2016;7(4):271-4.
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8. Wang R, Leong RW. Primary sclerosing cholangitis as an independent risk factor for colorectal cancer in the context of inflammatory bowel disease: a review of the literature. World journal of gastroenterology. 2014;20(27):8783-9.
9. Mosli M, Croome K, Qumosani K, Al-Judaibi B, Beaton M, Marotta P, et al. The effect of liver transplantation for primary sclerosing cholangitis on disease activity in patients with inflammatory bowel disease. Gastroenterology & hepatology. 2013;9(7):434-41.
10. Navaneethan U, Venkatesh PG, Mukewar S, Lashner BA, Remzi FH, McCullough AJ, et al. Progressive primary sclerosing cholangitis requiring liver transplantation is associated with reduced need for colectomy in patients with ulcerative colitis. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. 2012;10(5):540-6.
11. Gidwaney NG, Pawa S, Das KM. Pathogenesis and clinical spectrum of primary sclerosing cholangitis. World Journal of gastroenterology. 2017; 23(14):2459-2469.
12. Navaneethan U. Hepatobiliary manifestations of ulcerative colitis: an example of gut-liver crosstalk. Gastroenterol Rep (Oxf) 2014;2(3):193–200. doi: 10.1093/gastro/gou036.
13. Sabino J, Vieira-Silva S, Machiels K, et al. Primary sclerosing cholangitis is characterized by intestinal dysbiosis independent from IBD. GUT 2016;65: 1681–1689.
14. Takakura WR, Tabibian JH, Bowlus CL. The evolution of natural history of primary sclerosing cholangitis. Current opinion in gastroenterology. 2017;33(2):71-7.
15. Loftus Jr. EV, Aguilar HI, Sandborn WJ, Tremaine WJ, Krom RA, Zinsmeister AR, Graziadei IW, Wiesner RH, Risk of Colorectal Neoplasia in Patients With Primary Sclerosing Cholangitis and Ulcerative Colitis Following Orthotopic Liver Transplantation. Hepatology. 1998 Mar;27(3):685-90.
16. Lindstrom L, Jorgensen KK, Boberg KM, Castedal M, Rasmussen A, Rostved AA, et al. Risk factors and prognosis for recurrent primary sclerosing cholangitis after liver transplantation: A Nordic Multicentre Study. Scandinavian journal of gastroenterology. 2018;53(3):297-304.
17. Ravikumar R, Tsochatzis E, Jose S, Allison M, Athale A, Creamer F, Gunson B, Iyer V, Madanur M, Manas D, Monaco1 A, Mirza D, Owen N, Roberts K, Sen G, Srinivasan P, Wigmore S, Fusai G, Fernando B, Burroughs A, Risk factors for recurrent primary sclerosing cholangitis after liver transplantation. Journal of Hepatology. 2015; 63 j 1139–1146
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19. Rowe IA, Webb K, Gunson BK, Mehta N, Haque S, Neuberger J. The impact of disease recurrence on graft survival following liver transplantation: a single centre experience. Transpl Int. 2008; 21:459–465.
20. Alabraba E, Nightingale P, Gunson B, Hubscher S, Olliff S, Mirza D, Neuberger J. A re-evaluation of the risk factors for the recurrence of primary sclerosing cholangitis in liver allografts. Liver Transpl. 2009; 15:330–340.
21. Hildebrand T, Pannicke N, Dechene A, Gotthardt DN, Kirchner G, Reiter FP, et al. Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis: A retrospective multicenter analysis. Liver transplantation: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2016;22(1):42-52.
22. Verdonk RC, Dijkstra G, Haagsma EB, Shostrom VK, Van den Berg AP, Kleibeuker JH, et al. Inflammatory bowel disease after liver transplantation: risk factors for recurrence and de novo disease. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2006;6(6):1422-9.
23. Gelley F, Zadori G, Gorog D, Kobori L, Fehervari I, Gaman G, et al. Recurrence of primary sclerosing cholangitis after liver transplantation - The Hungarian experience. Interventional medicine & applied science. 2014;6(1):16-8.
24. Bajer L, Slavcev A, Macinga P, Sticova E, Brezina J, Roder M, et al. Risk of recurrence of primary sclerosing cholangitis after liver transplantation is associated with de novo inflammatory bowel disease. World journal of gastroenterology. 2018;24(43):4939-49.
25. Levy C. Can We Avoid Primary Sclerosing Cholangitis Recurrence? Liver Transplantation. 2016; 22: 12-13.
26. Shaikh SA, Fitzgerald L, Tischer S. Safety and Efficacy of Biologic Agents for the Management of Inflammatory Bowel Disease After Liver Transplantation. Pharmacotherapy. 2017;37(12):1578-85.
27. Carbone M, Neuberger J. Liver transplantation in PBC and PSC: indications and disease recurrence. Clinics and research in hepatology and gastroenterology. 2011;35(6-7):446-54.
28. Kowdley KV, Primary sclerosing cholangitis: Inflammatory bowel disease and colorectal cancer, Uptodate
29. Indriolo A, Ravelli P. Clinical management of inflammatory bowel disease in the organ recipient. World journal of gastroenterology. 2014;20(13):3525-33.
30. Ho GT, Seddon AJ, Therapondos G, Satsangi J, Hayes PC. The clinical course of ulcerative colitis after orthotopic liver transplantation for primary sclerosing cholangitis: further appraisal of immunosuppression post transplantation. Eur J Gastroenterol Hepatol 2005; 17: 1379-1385.
31. Singh S, Loftus EVJr, Talwalka JA. Inflammatory bowel disease after liver transplantation for primary sclerosing cholangitis. Am J Gastroenterol 2013; 108:1417–25.
32. Navaneethan U, Choudhary M, Venkatesh PG, Lashner BA, Remzi FH, Shen B, et al. The effects of liver transplantation on the clinical course of colitis in ulcerative colitis patients with primary sclerosing cholangitis. Alimentary pharmacology & therapeutics. 2012;35(9):1054-63.
33. Fattahi MR, Malek-Hosseini SA, Sivandzadeh GR, Safarpour AR, Bagheri Lankarani K, Taghavi AR, et al. Clinical Course of Ulcerative Colitis After Liver Transplantation in Patients with Concomitant Primary Sclerosing Cholangitis and Ulcerative Colitis. Inflammatory bowel diseases. 2017;23(7):1160-7.
34. Papatheodoridis GV, Hamilton M, Mistry PK, Davidson B, Rolles K, Burroughs AK. Ulcerative colitis has an aggressive course after orthotopic liver transplantation for primary sclerosing cholangitis. Gut. 1998;43(5):639-44.
35. Joshi D, Bjarnason I, Belgaumkar A, O'Grady J, Suddle A, Heneghan MA, et al. The impact of inflammatory bowel disease post-liver transplantation for primary sclerosing cholangitis. Liver international: official journal of the International Association for the Study of the Liver. 2013;33(1):53-61.
36. Befeler AS, Lissoos TW, Schiano TD, Conjeevaram H, Dasgupta KA, Millis JM, et al. Clinical course and management of inflammatory bowel disease after liver transplantation. Transplantation. 1998;65(3):393-6.
37. Verdonk RC, Haagsma EB, Van Den Berg AP, Karrenbeld A, Slooff MJ, Kleibeuker JH, et al. Inflammatory bowel disease after liver transplantation: a role for cytomegalovirus infection. Scandinavian journal of gastroenterology. 2006;41(2):205-11.
38. Jorgensen KK, Lindstrom L, Cvancarova M, Karlsen TH, Castedal M, Friman S, et al. Immunosuppression after liver transplantation for primary sclerosing cholangitis influences activity of inflammatory bowel disease. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. 2013;11(5):517-23.
39. Filipec Kanizaj T, Mijic M. Inflammatory bowel disease in liver transplanted patients. World journal of gastroenterology. 2017;23(18):3214-27.
40. Nannegari V, Saenz R, Rubin D, Quera R. A review of inflam-matory bowel disease in the setting of liver transplantation. Gastroenterol Hepatol (NY). 2014; 10:626-30.
41. Worns MA, Lohse AW, Neurath MF, Croxford A, Otto G, Kreft A, et al. Five cases of de novo inflammatory bowel disease after orthotopic liver transplantation. The American journal of gastroenterology. 2006;101(8):1931-7.
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