Re: PSC and IBD

[Guest guest]

Hello Dave and others:

I was mainly inquiring about the prevalence of small duct PSC and

IBD, rather than classic PSC and IBD. From what I've read, in order

to confirm a diagnosis of small duct PSC, the patient MUST also have

IBD. I'm aware that there is a minority of classic PSC cases where

there is no IBD, but small duct PSC apparently coexists with IBD 100%

of the time.

Please let me know if anyone finds out otherwise.

Husband Fred, PSC (small duct, we think!) 03/04

[Guest guest]

Hi ;

Sorry I didn't fully answer your question earlier. I have not found

anything that would contradict your conclusion about the association

between small duct PSC and IBD. For example, Kim, Ludwig and Lindor

(2000) write .... " Isolated small duct PSC is diagnosed if patients

have inflammatory bowel disease, biopsy features compatible with PSC,

but a normal cholangiogram. " :

Kim WR, Ludwig J, Lindor KD 2000 Variant forms of cholestatic

diseases involving small bile ducts in adults. Am. J. Gastroenterol.

95: 1130-1138.

So, is Fred an exception, with small duct PSC without IBD? Or is it

possible that Fred has a mild form of IBD that has not yet been

diagnosed, perhaps like the form(s) of IBD described in the Uchida et

al paper posted earlier?

The health benefits of checking for IBD might be that, if found, it

would be possible to get this into remission early, and perhaps help

prevent colorectal cancer from developing over the long-term (?):

Allgayer H 2003 Review article: mechanisms of action of mesalazine in

preventing colorectal carcinoma in inflammatory bowel disease.

Aliment. Pharmacol. Ther. 18 Suppl. 2: 10-14.

Best regards,

Dave

[Guest guest]

Thanks for the response and the references, Dave. Your first

reference about the IBD and small duct PSC connection is the one I

read. I am surprised that Fred's hepatologist didn't recommend a

colonoscopy, since there is a much higher risk of colon cancer with

untreated UC, and most PSC patients have some form of IBD.

Do I recall that Urso protects against colon cancer? Or does it

mainly protect against bile duct and liver cancer? Anyone know off

the top of their head?

Husband Fred PSC 03/04

[Guest guest]

Yes, , there are some reports that ursodiol (UCDA) protects

against colon cancer. One of them is shown below:

Gastroenterology. 2003 Apr;124(4):889-93

Ursodeoxycholic acid as a chemopreventive agent in patients with

ulcerative colitis and primary sclerosing cholangitis.

Pardi DS, Loftus EV Jr, Kremers WK, Keach J, Lindor KD.

Division of Gastroenterology and Hepatology and Division of

Biostatistics, Mayo Clinic and Foundation, Rochester, Minnesota

55905, USA. pardi.darrell@...

BACKGROUND & AIMS: Ursodeoxycholic acid (UDCA) has shown

effectiveness as a colon cancer chemopreventive agent in preclinical

studies. In addition, a recent report suggests that it also may

decrease the risk for developing colorectal dysplasia in patients

with ulcerative colitis (UC) and primary sclerosing cholangitis

(PSC). We sought to evaluate the effect of UDCA on colorectal

neoplasia in a group of patients with UC and PSC enrolled in a

randomized, placebo-controlled trial. METHODS: From a prior,

randomized, placebo-controlled trial of UDCA therapy in PSC at our

center, we followed-up patients with concomitant UC to assess the

effect of UDCA on the development of colorectal dysplasia and cancer

as compared with placebo. ReESULTS: Fifty-two subjects were followed-

up for a total of 355 person-years. Those originally assigned to

receive UDCA had a relative risk of 0.26 for developing colorectal

dysplasia or cancer (95% confidence interval, 0.06-0.92; P = 0.034).

Many of the patients originally assigned to the placebo group

eventually received open-label UDCA. Assigning these patients to the

UDCA group from the time they began active therapy did not change the

magnitude of the protective effect (relative risk, 0.26; 95%

confidence interval, 0.07-0.99; P = 0.049). CONCLUSIONS: UDCA

significantly decreases the risk for developing colorectal dysplasia

or cancer in patients with UC and PSC.

Publication Types:

Clinical Trial

Randomized Controlled Trial

PMID: 12671884

Best regards,

Dave

[Guest guest]

,

You recall correctly, although " protects " is probably too strong a

word. I would say " Urso reduces the incidence of colon cancer, "

based on the reported reduced incidence of pre-cancerous polops in

PSC patients being treated with URSO relative to those that went

untreated.

Tim R

> Do I recall that Urso protects against colon cancer? Or does it

> mainly protect against bile duct and liver cancer? Anyone know off

> the top of their head?

>

>

> Husband Fred PSC 03/04