Colectomy in patients with ulcerative colitis is not associated to future diagnosis of primary sclerosing cholangitis

Aiva Lundberg Båve; Ola Olén; Jonas Söderling; Jonas F. Ludvigsson; Annika Bergquist; Caroline Nordenvall; SWIBREG Study Group

doi:10.1002/ueg2.12388

Colectomy in patients with ulcerative colitis is not associated to future diagnosis of primary sclerosing cholangitis

Aiva Lundberg Båve, Ola Olén, Jonas Söderling, Jonas F. Ludvigsson, Annika Bergquist (medarbetare), Caroline Nordenvall, SWIBREG Study Group

Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

Sammanfattning

Background: Primary Sclerosing Cholangitis (PSC) is a hepatobiliary disease closely related to ulcerative colitis (UC). In PSC patients, colectomy has been linked to improved prognosis, especially following liver transplantation. This suggests an involvement of the gut-liver axis in PSC etiology. Objective: We aimed to investigate the association between colectomy and the risk of future PSC in an epidemiological setting. Method: Through nationwide registers, we identified all adults diagnosed with UC in Sweden 1990–2018 and retrieved information on PSC diagnosis and colectomy. Within the UC cohort (n = 61,993 patients), we matched 5577 patients with colectomy to 15,078 without colectomy. Matching criteria were sex, age at UC onset (±5 years), year of UC onset (±3 years), and proctitis at the time of colectomy. Incidence rates of PSC per 1000-person year were calculated, and the Cox proportional hazard regression model estimated hazard ratios (HRs) for PSC until 31 December 2019. Results: During the follow-up, 190 (3.4%) colectomized UC patients and 450 (3.0%) UC comparators developed PSC, yielding incidence rates of 2.6 and 2.4 per 1000 person-years (HR 1.07 [95% CI 0.90–1.28]). The cumulative incidence of colectomy decreased remarkably over calendar periods, but the cumulative incidence of PSC remained unchanged. The risk of developing PSC in colectomized versus comparators changed over time (HR 0.68 [95% CI; 0.48–0.96] in 1990-97 and HR 2.10 [95% CI; 1.37–3.24] in 2011-18). Conclusions: In UC patients, colectomy was not associated with a decreased risk of subsequent PSC. The observed differences in the risk of PSC development over calendar periods are likely due to changes in PSC-diagnosis and UC-treatment.

Originalspråk	engelska
Sidor (från-till)	471-481
Tidskrift	United European Gastroenterology Journal
Volym	11
Nummer	5
DOI	https://doi.org/10.1002/ueg2.12388
Status	Published - 2023
Externt publicerad	Ja

Bibliografisk information

Funding Information:
This study was funded by Region Stockholm (clinical research appointment), Bengt Ihre research fellowship, Bengt Ihre foundation and Ruth and Richard Julin foundation. We acknowledge the members of the SWIBREG study group: Olof Grip: Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden. Susanna Jäghult: Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. Pär Myrelid: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, County Council of Östergötland, Linköping, Sweden. Jonas Bengtsson: Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. Michael Eberhardson: Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden. Martin Rejler: Department of Medicine, Höglandssjukhuset Eksjö, Region Jönköping County Council, Jönköping, Sweden; Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden. Pontus Karling: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. Malin Olsson: Department of Surgery, County Council of Östergötland, Linköping, Sweden. Marie Andersson: Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden. Ulrika L. Fagerberg: Center for Clinical Research, Västmanland Hospital, Västerås, Sweden and Uppsala University, Uppsala, Sweden; Department of Pediatrics, Västmanland Hospital, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Henrik Hjortswang: Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden. Jonas Halfvarson: Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. Hans Strid: Department of gastroenterology, dermatology, and rheumatology, Karolinska Universitetssjukhuset, Stockholm Sweden.

Funding Information:
This study was funded by Region Stockholm (clinical research appointment), Bengt Ihre research fellowship, Bengt Ihre foundation and Ruth and Richard Julin foundation. We acknowledge the members of the SWIBREG study group: Olof Grip: Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden. Susanna Jäghult: Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. Pär Myrelid: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, County Council of Östergötland, Linköping, Sweden. Jonas Bengtsson: Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. Michael Eberhardson: Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden. Martin Rejler: Department of Medicine, Höglandssjukhuset Eksjö, Region Jönköping County Council, Jönköping, Sweden; Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden. Pontus Karling: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. Malin Olsson: Department of Surgery, County Council of Östergötland, Linköping, Sweden. Marie Andersson: Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden. Ulrika L. Fagerberg: Center for Clinical Research, Västmanland Hospital, Västerås, Sweden and Uppsala University, Uppsala, Sweden; Department of Pediatrics, Västmanland Hospital, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Henrik Hjortswang: Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden. Jonas Halfvarson: Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. Hans Strid: Department of gastroenterology, dermatology, and rheumatology, Karolinska Universitetssjukhuset, Stockholm Sweden.

Publisher Copyright:
© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.

Ämnesklassifikation (UKÄ)

Gastroenterologi

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10.1002/ueg2.12388Licens: CC BY-NC-ND

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@article{6ef2aa1a562c41f1a1a7c6f4b9f43076,

title = "Colectomy in patients with ulcerative colitis is not associated to future diagnosis of primary sclerosing cholangitis",

abstract = "Background: Primary Sclerosing Cholangitis (PSC) is a hepatobiliary disease closely related to ulcerative colitis (UC). In PSC patients, colectomy has been linked to improved prognosis, especially following liver transplantation. This suggests an involvement of the gut-liver axis in PSC etiology. Objective: We aimed to investigate the association between colectomy and the risk of future PSC in an epidemiological setting. Method: Through nationwide registers, we identified all adults diagnosed with UC in Sweden 1990–2018 and retrieved information on PSC diagnosis and colectomy. Within the UC cohort (n = 61,993 patients), we matched 5577 patients with colectomy to 15,078 without colectomy. Matching criteria were sex, age at UC onset (±5 years), year of UC onset (±3 years), and proctitis at the time of colectomy. Incidence rates of PSC per 1000-person year were calculated, and the Cox proportional hazard regression model estimated hazard ratios (HRs) for PSC until 31 December 2019. Results: During the follow-up, 190 (3.4%) colectomized UC patients and 450 (3.0%) UC comparators developed PSC, yielding incidence rates of 2.6 and 2.4 per 1000 person-years (HR 1.07 [95% CI 0.90–1.28]). The cumulative incidence of colectomy decreased remarkably over calendar periods, but the cumulative incidence of PSC remained unchanged. The risk of developing PSC in colectomized versus comparators changed over time (HR 0.68 [95% CI; 0.48–0.96] in 1990-97 and HR 2.10 [95% CI; 1.37–3.24] in 2011-18). Conclusions: In UC patients, colectomy was not associated with a decreased risk of subsequent PSC. The observed differences in the risk of PSC development over calendar periods are likely due to changes in PSC-diagnosis and UC-treatment.",

keywords = "colectomy, IBD, inflammatory bowel disease, primary sclerosing cholangitis, ulcerative colitis",

author = "{Lundberg B{\aa}ve}, Aiva and Ola Ol{\'e}n and Jonas S{\"o}derling and Ludvigsson, {Jonas F.} and Annika Bergquist and Caroline Nordenvall and Olof Grip and Susanna J{\"a}ghult and P{\"a}r Myrelid and Jonas Bengtsson and Michael Eberhardson and Martin Rejler and Pontus Karling and Malin Olsson and Marie Andersson and Fagerberg, {Ulrika L.} and Henrik Hjortswang and Jonas Halfvarson and Hans Strid and {SWIBREG Study Group}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.",

year = "2023",

doi = "10.1002/ueg2.12388",

language = "English",

volume = "11",

pages = "471--481",

journal = "United European Gastroenterology Journal",

issn = "2050-6406",

publisher = "SAGE Publications",

number = "5",

}

TY - JOUR

T1 - Colectomy in patients with ulcerative colitis is not associated to future diagnosis of primary sclerosing cholangitis

AU - Lundberg Båve, Aiva

AU - Olén, Ola

AU - Söderling, Jonas

AU - Ludvigsson, Jonas F.

AU - Nordenvall, Caroline

AU - SWIBREG Study Group

A2 - Bergquist, Annika

A2 - Grip, Olof

A2 - Jäghult, Susanna

A2 - Myrelid, Pär

A2 - Bengtsson, Jonas

A2 - Eberhardson, Michael

A2 - Rejler, Martin

A2 - Karling, Pontus

A2 - Olsson, Malin

A2 - Andersson, Marie

A2 - Fagerberg, Ulrika L.

A2 - Hjortswang, Henrik

A2 - Halfvarson, Jonas

A2 - Strid, Hans

PY - 2023

Y1 - 2023

N2 - Background: Primary Sclerosing Cholangitis (PSC) is a hepatobiliary disease closely related to ulcerative colitis (UC). In PSC patients, colectomy has been linked to improved prognosis, especially following liver transplantation. This suggests an involvement of the gut-liver axis in PSC etiology. Objective: We aimed to investigate the association between colectomy and the risk of future PSC in an epidemiological setting. Method: Through nationwide registers, we identified all adults diagnosed with UC in Sweden 1990–2018 and retrieved information on PSC diagnosis and colectomy. Within the UC cohort (n = 61,993 patients), we matched 5577 patients with colectomy to 15,078 without colectomy. Matching criteria were sex, age at UC onset (±5 years), year of UC onset (±3 years), and proctitis at the time of colectomy. Incidence rates of PSC per 1000-person year were calculated, and the Cox proportional hazard regression model estimated hazard ratios (HRs) for PSC until 31 December 2019. Results: During the follow-up, 190 (3.4%) colectomized UC patients and 450 (3.0%) UC comparators developed PSC, yielding incidence rates of 2.6 and 2.4 per 1000 person-years (HR 1.07 [95% CI 0.90–1.28]). The cumulative incidence of colectomy decreased remarkably over calendar periods, but the cumulative incidence of PSC remained unchanged. The risk of developing PSC in colectomized versus comparators changed over time (HR 0.68 [95% CI; 0.48–0.96] in 1990-97 and HR 2.10 [95% CI; 1.37–3.24] in 2011-18). Conclusions: In UC patients, colectomy was not associated with a decreased risk of subsequent PSC. The observed differences in the risk of PSC development over calendar periods are likely due to changes in PSC-diagnosis and UC-treatment.

AB - Background: Primary Sclerosing Cholangitis (PSC) is a hepatobiliary disease closely related to ulcerative colitis (UC). In PSC patients, colectomy has been linked to improved prognosis, especially following liver transplantation. This suggests an involvement of the gut-liver axis in PSC etiology. Objective: We aimed to investigate the association between colectomy and the risk of future PSC in an epidemiological setting. Method: Through nationwide registers, we identified all adults diagnosed with UC in Sweden 1990–2018 and retrieved information on PSC diagnosis and colectomy. Within the UC cohort (n = 61,993 patients), we matched 5577 patients with colectomy to 15,078 without colectomy. Matching criteria were sex, age at UC onset (±5 years), year of UC onset (±3 years), and proctitis at the time of colectomy. Incidence rates of PSC per 1000-person year were calculated, and the Cox proportional hazard regression model estimated hazard ratios (HRs) for PSC until 31 December 2019. Results: During the follow-up, 190 (3.4%) colectomized UC patients and 450 (3.0%) UC comparators developed PSC, yielding incidence rates of 2.6 and 2.4 per 1000 person-years (HR 1.07 [95% CI 0.90–1.28]). The cumulative incidence of colectomy decreased remarkably over calendar periods, but the cumulative incidence of PSC remained unchanged. The risk of developing PSC in colectomized versus comparators changed over time (HR 0.68 [95% CI; 0.48–0.96] in 1990-97 and HR 2.10 [95% CI; 1.37–3.24] in 2011-18). Conclusions: In UC patients, colectomy was not associated with a decreased risk of subsequent PSC. The observed differences in the risk of PSC development over calendar periods are likely due to changes in PSC-diagnosis and UC-treatment.

KW - colectomy

KW - IBD

KW - inflammatory bowel disease

KW - primary sclerosing cholangitis

KW - ulcerative colitis

U2 - 10.1002/ueg2.12388

DO - 10.1002/ueg2.12388

M3 - Article

C2 - 37169725

AN - SCOPUS:85159098254

SN - 2050-6406

VL - 11

SP - 471

EP - 481

JO - United European Gastroenterology Journal

JF - United European Gastroenterology Journal

IS - 5

ER -

Colectomy in patients with ulcerative colitis is not associated to future diagnosis of primary sclerosing cholangitis

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