The risk for cancer or dysplasia in ulcerative colitis patients with primary sclerosing cholangitis

Kirti Shetty, Lisa Rybicki, Aaron Brzezinski, William D. Carey, Bret A. Lashner

Research output: Contribution to journalArticlepeer-review

233 Scopus citations


OBJECTIVES: Recent studies have implicated primary sclerosing cholangitis (PSC) as a risk factor for colorectal cancer (CRC) in ulcerative colitis (UC). Our study was designed to define both the risk and the risk factors for CRC or dysplasia in a large UC cohort with PSC. METHODS: Patients with UC and PSC were compared with a random sample of UC controls without PSC. Patients were analyzed from the inception of disease until an outcome or censor. RESULTS: Thirty-three (25%) of 132 UC patients with PSC developed CRC or dysplasia compared with 11 (5.6%) of 196 controls (adjusted relative risk 3.15, 95% confidence interval 1.37-7.27). Possible risk factors were chronic disease activity and lack of folate supplementation. Of 17 CRCs in the PSC group, 76% occurred proximal to the splenic flexure and 35% presented at an advanced stage, compared with one of five (20%) CRCs in controls being proximal and none being advanced. Six (4.5%) PSC patients, and no controls, died of CRC (p < 0.01). CONCLUSIONS: UC patients with PSC are at increased risk of developing CRC or dysplasia. Chronically active disease may be a risk factor, whereas folate could have a protective effect. CRCs associated with PSC are more likely to be proximal, to be diagnosed at a more advanced stage, and to be fatal.

Original languageEnglish (US)
Pages (from-to)1643-1649
Number of pages7
JournalAmerican Journal of Gastroenterology
Issue number6
StatePublished - Jun 1999

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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