Concomitant colitis associated with primary sclerosing cholangitis

Abstract

Between 1985 and 2001, seven Japanese patients (four males and three females) were diagnosed as having primary sclerosing cholangitis (PSC) in our hospital. All seven patients received total colonoscopy with distal ileoscopy. All four male patients were diagnosed as having colitis by colonoscopy, while none of the three female patients had colitis. The four patients with colitis did not have any symptoms attributable to colitis, such as diarrhea or hematochezia. In three of the four patients, unclassified colitis was the most suitable diagnosis, because there were no typical findings of ulcerative colitis or Crohn's disease. The remaining patient was diagnosed as having eosinophilic colitis. By colonoscopic visualization, the right-sided colon, including the terminal ileum, was mainly involved, but the lesions were not severe. The main findings were redness, erosion, stenosis, and insufficiency of haustral formation. Histologically, these lesions were nonspecific inflammatory changes in the three patients with unclassified colitis. In the patient with eosinophilic colitis, remarkable infiltration of eosinophils was observed. Thus, unclassified colitis appeared to be the main complication in these patients with PSC. Males predominated in regard to concomitant colitis, and they had no symptoms of the colitis. Colonoscopic examination revealed that the lesions were not severe. The main lesions were found in the right-sided colon, with nonspecific inflammatory changes. These results suggest that colonoscopic surveillance of patients with PSC should be performed even if they do not have any colitis symptoms.

Concurrent Primary Sclerosing Cholangitis and Eosinophilic Colitis

“…In fact, steroid dependence has been reported in some patients with eosinophilic colitis (7). In contrast, concurrent PSC and eosinophilic colitis, as noted in the present report, has only been reported in two previous cases (8,9). However, considering that PSC is often associated with eosinophilia (10)(11)(12) and that some cases may be reported as unclassifiable enteritis or ulcerative colitis with an increased eosinophil count (2,13), additional similar cases may have been overlooked and consequently not reported.…”

Clinicopathological differentiation between sclerosing cholangitis with autoimmune pancreatitis and primary sclerosing cholangitis

“…The latter type of colitis was considered consistent with the so-called colitis associated with PSC that has been proposed by several other authors. 24,25 The SC-AIP in our study, however, was never complicated by infl ammatory bowel disease.…”

Editor's quiz: GI Snapshot

“…None in this small cohort developed a liver biochemical abnormality to prompt investigation for PSC or autoimmune hepatitis over a subsequent follow up of a mean of 4.0 (0. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] years.…”

“…There is also a substantial literature indicating that patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (PSC-IBD) have, in general, a milder [10][11][12] but more extensive colitis, [13][14][15][16] which is often not a classical UC or Crohn's disease phenotype. 12 16 The more extensive colitis of PSC-IBD is associated with a higher incidence of dysplasia, dysplasia associated lesions and masses, and colorectal cancer, compared with those patients with classical UC.…”

“…12 16 The more extensive colitis of PSC-IBD is associated with a higher incidence of dysplasia, dysplasia associated lesions and masses, and colorectal cancer, compared with those patients with classical UC. 15 [17][18][19] This may arise from the chronic inflammation of the underlying extensive colitis, which is often undertreated because it is clinically mild.…”