Background: Primary Sclerosing Cholangitis (PSC), a chronic liver disease, is often intertwined with Inflammatory Bowel Disease (IBD), presenting a complex clinical scenario. The coexistence of IBD-PSC complicates disease management and progression, potentially exacerbating outcomes. This study aims to evaluate the specific impact of IBD in patients with PSC, focusing on both liver-related and IBD-specific clinical outcomes, to inform more effective management strategies for this patient subgroup.

Methods: This retrospective study, utilizing the TriNetX database, performed propensity score matching to compare clinical outcomes between IBD-PSC and PSC-only patients, as well as IBD-PSC and IBD-only patients. The analysis focused on key outcomes including mortality, hospitalization, emergency department (ED) visits, ICU admissions, IBD related complications, liver complications, and cancer incidences. Hazard ratios (HR) with 95% confidence intervals (CI) and log-rank test P-values were used to assess the risk and survival differences.

Results: The study comprised 5,918 IBD-PSC patients. In the IBD-PSC vs. IBD-only comparison, IBD-PSC patients exhibited a significantly higher mortality rate (10.7% vs. 3.8%; HR: 2.145, 95% CI: 1.843 - 2.497, P<0.0001), increased hospitalization (30.1% vs. 14.6%; HR: 1.814, 95% CI: 1.665 - 1.975, P<0.0001), and elevated risks of toxic megacolon (0.6% vs. 0.2%; HR: 3.780, 95% CI: 1.674 - 8.536, P=0.001), pancolitis (32.7% vs. 7.9%; HR: 3.853, 95% CI: 3.467 - 4.283, P<0.0001), and colorectal cancer (5.7% vs. 1.4%; HR: 3.139, 95% CI: 2.467 - 3.993, P<0.0001). In the IBD-PSC vs. PSC-only comparison, focusing on liver-related outcomes, the IBD-PSC group had similar rate of liver transplantation (12.4% vs. 8.1%; HR: 0.945, 95% CI: 0.802 – 1.113, P=0.499) and hepatocellular carcinoma (8.2% vs. 4.8%; HR: 1.046, 95% CI: 0.854 – 1.281, P=0.663).(Table 1,2)

Conclusion: Our study highlights the significantly elevated clinical severity in patients with co-existing IBD and PSC, as evidenced by higher mortality rates, increased hospitalization, and greater risks of IBD-specific complications like toxic megacolon, pancolitis, and colorectal cancer. These findings underline the necessity for a tailored and vigilant approach in the management of IBD-PSC patients, considering the synergistic impact of these comorbid conditions. Clinically, our results advocate for more intensive monitoring and possibly early intervention strategies in this patient subgroup. Future research should delve into the underlying pathophysiological interactions between IBD and PSC, aiming to uncover novel insights that could lead to more effective and targeted treatment modalities.

Venkat Arutla

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