IBD-PSC

 Q: Primary Sclerosing Cholangitis (PSC) is usually associated with? (select one)

A) Crohn's disease 

B) Ulcerative colitis

Answer: B

Almost 90 percent of patients with PSC have ulcerative colitis (UC), though vice versa is not necessary. This is due to the fact that patients who have both PSC and inflammatory bowel disease (IBD) carry a different phenotype than patients who have only IBD. All patients with IBD who have abnormal liver enzymes particularly serum alkaline phosphatase should undergo workup for PSC. 

Clinically distinct features of patients who have both UC and PSC is pancolitis with active histologic activity despite the minimal endoscopic activity.

#GI

References:

1. Tung BY, Brentnall T, Kowdley KV, et al. Diagnosis and prevalence of ulcerative colitis in patients with sclerosing cholangitis (abstract). Hepatology 1996; 24:169A. 

2. Loftus EV Jr, Harewood GC, Loftus CG, et al. PSC-IBD: a unique form of inflammatory bowel disease associated with primary sclerosing cholangitis. Gut 2005; 54:91. 

3. Boonstra K, van Erpecum KJ, van Nieuwkerk KM, et al. Primary sclerosing cholangitis is associated with a distinct phenotype of inflammatory bowel disease. Inflamm Bowel Dis 2012; 18:2270. 

4. Jørgensen KK, Grzyb K, Lundin KE, et al. Inflammatory bowel disease in patients with primary sclerosing cholangitis: clinical characterization in liver transplanted and nontransplanted patients. Inflamm Bowel Dis 2012; 18:536.