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Variables Patients without hepatobiliary diseases n (%) Patients with hepatobiliary diseases n (%) Total n (%) P-value IBD Crohn’s disease 478 (56.4) 12 (31.6) 490 (55.4) 0.0090 UC 348 (41.1) 25 (65.8) 373 (42.1) Unclassified 21 (2.5) 1 (2.6) 22 (2.5) CD site Ileal 125 (14.8) 3 (7.9) 128 (14.5) 0.0450 Ileocolic 273 (32.2) 7 (18.4) 280 (31.6) Colic 68 (8.0) 2 (5.3) 70 (7.9) UC site Proctitis 67 (7.9) 5 (13.2) 72 (8.1) 0.0150 Left sided 132 (15.6) 12 (31.6) 144 (16.3) Pancolitis 138 (16.3) 7 (18.4) 145 (16.4) IBD behavior Inflammatory 221 (26.1) 7 (18.4) 228 (25.8) 0.0280 Penetrating 117 (13.8) 3 (7.9) 120 (13.6) Structuring 134 (15.8) 2 (5.3) 136 (15.4) IBD behavior Inflammatory 221 (46.8) 7 (58.3) 228 (25.8) 0.679 Penetrating 117 (24.8) 3 (25.0) 120 (13.6) Stricturing 134 (28.4) 2 (16.7) 136 (15.4) Perianal disease Yes 109 (13.0) 3 (7.9) 112 (12.7) 0.5050 Medications Mesalazine 467 (58.8) 16 (59.3) 483 (58.8) 1.0000 Corticosteroids 493 (64.3) 17 (65.4) 510 (64.3) 1.0000 Adalimumab 58 (6.8) 11 (28.9) 69 (7.8) <0.001 Infliximab 73 (8.6) 7 (18.4) 80 (9.0) 0.0760 Azathioprine 0 (0.0) 9 (23.7) 9 (1.0) <0.001 Vedolizumab 21 (2.5) 2 (5.3) 23 (2.6) 0.5930 Tofacitinib 3(0.4) 1(2.6) 4(0.5) 0.161 Surgical resection Yes 94 (11.1) 4 (10.5) 98 (11.1) 1.0000 Surgical resection Ileal resection 34 (4.0) 0 (0.0) 34 (3.8) 0.4080 Hemicolectomy 32 (3.8) 2 (5.3) 34 (3.8) 0.9720 Total colectomy 6 (0.7) 2 (5.3) 8 (0.9) 0.0430 Values are presented as numbers and percentages (%).
IBD: inflammatory bowel disease, UC: ulcerative colitis
Hepatobiliary diseases n (%) Primary sclerosing cholangitis 28 (73.7) Cholelithiasis 6 (15.8) Non-alcoholic steatohepatitis. 1 (2.6) Portal vein thrombosis 1 (2.6) Autoimmune hepatitis 1 (2.6) Viral hepatitis 1 (2.6) Pancreatitis 1 (2.6) Hepatic cysts 1 (2.6) - Table 3
- Characteristics of primary sclerosing cholangitis-associated in the study cohort.
Variables Patients without PSC n (%) Patients with PSC n (%) Total n (%) P-values Gender Male 438 (51.1) 11 (39.3) 449 (50.7) 0.252 Female 419 (48.9) 17 (60.7) 436 (49.3) Age Mean (SD) 34.6 (14.8) 43.9 (16.8) 34.9 (15.0) 0.001 Smoking No 583 (87.9) 20 (95.2) 603 (88.2) 0.496 Yes 80 (12.1) 1 (4.8) 81 (11.8) IBD CD 484 (57.9) 6 (22.2) 490 (56.8) <0.001 UC 352 (42.1) 21 (77.8) 373 (43.2) Age at diagnosis Mean (SD) 25.4 (13.2) 30.6 (14.7) 25.6 (13.2) 0.044 CD site Ileal 126 (14.7) 2 (7.1) 128 (14.5) 0.007 Ileocolic 277 (32.3) 3 (10.7) 280 (31.6) Colic 69 (8.1) 1 (3.6) 70 (7.9) UC site Ulcerative proctitis 67 (7.8) 5 (17.9) 72 (8.1) <0.001 Left-sided colitis 133 (15.5) 11 (39.3) 144 (16.3) Pancolitis 140 (16.3) 5 (17.9) 145 (16.4) IBD behavior Inflammatory 225 (26.3) 3 (10.7) 228 (25.8) 0.005 Perforating 118 (13.8) 2 (7.1) 120 (13.6) Structuring 135 (15.8) 1 (3.6) 136 (15.4) Unknown 379 (44.2) 22 (78.6) 401 (45.3) Perianal surgery Yes 0 (0.0) 2 (7.1) 2 (0.2) 0.001 Perianal disease Yes 110 (12.9) 2 (7.1) 112 (12.7) 0.564 Perianal diseases Fistula 94 (11.0) 1 (3.6) 95 (10.7) 0.350 Fissure 1 (0.1) 1 (3.6) 2 (0.2) 0.062 Abscess 1 (0.1) 1 (3.6) 2 (0.2) 0.062 Extraintestinal manifestation Arthralgias 206 (24.0) 19 (67.9) 225 (25.4) <0.001 Erythema nodosum 41 (4.8) 1 (3.6) 42 (4.7) 1.000 Ocular(uveitis, scleritis) 24 (2.8) 2 (7.1) 26 (2.9) 0.197 Pyoderma gangrenosum 19 (2.2) 1 (3.6) 20 (2.3) 0.478 Medications Corticosteroids 499 (64.2) 11 (68.8) 510 (64.3) 0.798 Mesalamine/ Pentasa 471 (58.6) 12 (70.6) 483 (58.8) 0.456 Infliximab 75 (8.8) 5 (17.9) 80 (9.0) 0.100 Adalimumab 59 (6.9) 10 (35.7) 69 (7.8) <0.001 Vedolizumab 21 (2.5) 2 (7.1) 23 (2.6) 0.162 Azathioprine 1 (0.1) 8 (28.6) 9 (1.0) <0.001 Tofacitinib 3 (0.4) 1 (3.6) 4 (0.5) 0.121 Previous surgical interventions Yes 96 (11.2) 2 (7.1) 98 (11.1) 0.760 PSC: primary sclerosing cholangitis, IBD: inflammatory bowel disease, CD: Crohn’s disease, UC: ulcerative colitis
Dependent: PSC OR (univariable) OR (multivariable) IBD 4.81 (2.04-13.22, p=0.001) 15.61 (4.33-76.82, p<0.001) Adalimumab 7.51 (3.21-16.74, p<0.001) 12.90 (3.47-53.99, p<0.001) Infliximab 2.27 (0.74-5.69, p=0.107) 4.88 (1.08-20.81, p=0.032) Gender 1.62 (0.76-3.59, p=0.222) 1.89 (0.68-5.57, p=0.231) Age at diagnosis 1.03 (1.00-1.05, p=0.046) 1.01 (0.97-1.04, p=0.748) Comorbidities 0.21 (0.10-0.45, p<0.001) 0.11 (0.03-0.32, p<0.001) Perianal disease 0.01 (0.00-0.04, p<0.001) 0.01 (0.00-0.04, p<0.001) PSC; primary sclerosing cholangitis, IBD; inflammatory bowel disease
Case definition Primary sclerosing cholangitis Described as a chronic cholestatic liver disorder marked by lesions in the intrahepatic and/or extrahepatic bile ducts.29 Non-alcoholic fatty liver disease known as the accumulation of fat in more than 5% of hepatocytes.29 Portal vein thrombosis The formation of a blood clot in the portal vein, Autoimmune hepatitis A long-term inflammatory liver condition marked by elevated levels of aminotransferases, the presence of anti-nuclear antibodies or anti-smooth muscle antibodies, increased immunoglobulin G (IgG) levels.30 Acute pancreatitis An inflammatory disorder of the pancreas.31 Simple hepatic cysts are generally sac-shaped, with thin walls and filled with fluid, lined by epithelial tissue.30 - Appendix 1
- Description of hepatobiliary pathology in individuals with inflammatory bowel disease.
Hepatobiliary pathology IBD Gender Age Diagnostic Management Other complications PSC UC Male 19 MRCP Medical Unknown PSC UC Male 13 LFT, Liver Biopsy Medical Unknown PSC CD Male 31 MRCP Endoscopy IDA PSC CD Male 33 Unknown Unknown IDA, osteoporosis PSC CD Female 38 MRI Unknown Unknown PSC UC Female 31 Unknown Unknown GERD PSC UC Female 31 Unknown Unknown Unknown PSC CD Female 66 LFT, CT, MRCP Endoscopy Rectal cancer PSC UC Female 49 MRI Unknown Unknown PSC UC Female 24 MRCP, CT Endoscopy Unknown PSC UC Female 37 Unknown Unknown Unknown PSC CD Female 36 Unknown Unknown Unknown PSC UC Female 49 Unknown Unknown Unknown PSC UC Female 62 Unknown Unknown Unknown PSC UC Female 46 Unknown Unknown gastroesophageal cancer with liver and lung metastasis PSC UC Female 39 Unknown Unknown Unknown PSC UC Male 45 Unknown Unknown Unknown PSC UC Male 48 Unknown Unknown Unknown PSC UC Female 77 Unknown Unknown Liver disease PSC UC Male 38 Unknown Unknown Unknown PSC UC Female 52 Unknown Unknown Unknown PSC UC Male 67 Unknown Unknown Esophageal varices PSC UC Male 42 Unknown Unknown Vitamin D deficiency, degenerative disc PSC UC Male 28 Unknown Unknown Urticaria PSC UC Female 79 Unknown Unknown Unknown PSC UC Male 34 Unknown Unknown Unknown PSC, Cholelithiasis CD Female 23 MRCP, Abdomen.US Surgical Unknown PSC, NASH UC Female 62 Abdomen.US Medical Unknown Cholelithiasis CD Male 42 LFT Surgical Unknown Cholelithiasis CD Female 33 Abdomen. US Medical Neurofibromatosis Cholelithiasis UC Male 68 Abdomen. US Surgical BPH Cholelithiasis UC Female 52 LFT, ERCP, Abdomen. US Surgical Unknown Cholelithiasis UC Female 45 LFT, ERCP, Abdomen. US Surgical Unknown Portal vein thrombosis CD Female 34 Unknown Unknown Pain in limp and swelling Viral hepatitis CD Male 27 LFT, antibody Follow up Unknown Pancreatitis CD Female 19 LFT, Amylase, lipase Medical Osteoporosis Hepatic cysts CD Female 67 CT Follow-up Unknown Autoimmune. Hepatitis UC Female 47 LFT, ERCP, MRCP Medical Liver cirrhosis PSC: primary sclerosing cholangitis, UC; Ulcerative colitis, MRCP: magnetic resonance cholangiopancreatography, LFT: liver function test, CD; Crohn’s disease, IDA: Iron deficiency anemia, MRI: Magnetic Resonance Imaging, CT: Compact tomography, US: ultrasound, NASH: Non-alcoholic steatohepatitis, ERCP: Endoscopic retrograde cholangiopancreatography.
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