The incidence of cholangiocarcinoma in primary sclerosing cholangitis after long-time treatment with ursodeoxycholic acid
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Abstract:
Cholangiocarcinoma represents a serious complication of primary sclerosing cholangitis. Ursodeoxycholic acid may possibly influence the incidence of cholangiocarcinoma in man. The aim of this study was to evaluate the incidence rate of cholangiocarcinoma in a large group of primary sclerosing cholangitis patients after long-time treatment with ursodeoxycholic acid.From May 1987 up to May 2005 a total of 150 patients with primary sclerosing cholangitis but without evidence of cholangiocarcinoma at entry were included in the study. All patients were treated with ursodeoxycholic acid and controls were performed in at least yearly intervals.The median treatment time of the 150 patients was 6.4 years. Altogether five patients developed a cholangiocarcinoma during treatment yielding a rate of 3.3%. The patients developed 0.58 cholangiocarcinoma per 100 patient-years in years 0-2.5, 0.59 cholangiocarcinoma in years 2.5-8.5, and no cholangiocarcinoma thereafter up to 18 years after entry into the study. The Kaplan-Meier estimate of cholangiocarcinoma incidence during ursodeoxycholic acid treatment reached a plateau after 8.3 years.The annual incidence rate of cholangiocarcinoma in primary sclerosing cholangitis treated with ursodeoxycholic acid is lower than expected and decreases with time of treatment.Keywords:
Ursodeoxycholic acid
Primary Sclerosing Cholangitis
Primary sclerosing cholangitis (PSC) is an uncommon cause of chronic liver disease; however, it can be associated with liver failure and cholangiocarcinoma. No effective medical therapy for PSC is known. Results from small pilot studies have suggested that ursodeoxycholic acid (UDCA) is effective in PSC. In this large, randomized, double-blind, multicenter Scandinavian study, researchers evaluated the effectiveness of …
Ursodeoxycholic acid
Primary Sclerosing Cholangitis
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Ursodeoxycholic acid
Primary Sclerosing Cholangitis
Primary (astronomy)
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No effective treatment has been identified for patients who have primary sclerosing cholangitis (PSC). Pilot studies have suggested that outcomes might
Ursodeoxycholic acid
Primary Sclerosing Cholangitis
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Eighty percent of patients with primary sclerosing cholangitis (PSC) have IBD. In this setting, IBD has been shown to have some unique characteristics, including an increased risk of colorectal cancer (CRC). Currently, there are no reports of a medical therapy that can be able to halt PSC progression. Ursodeoxycholic acid (UDCA) has been shown to exert some beneficial effects as measured by liver biochemistry. In addition, UDCA has been suggested to act as a chemopreventive agent against CRC in patients with PSC and IBD. However, a recent randomized, controlled, high-dose UDCA trial failed to demonstrate improvement in survival and was associated with increased rates of serious adverse events; the presence of IBD did not have any effect on outcomes. Taking all the available data into consideration, we suggest that UDCA cannot be generally be recommended in patients with PSC and IBD.
Ursodeoxycholic acid
Primary Sclerosing Cholangitis
Inflammatory Bowel Diseases
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Cholangiocarcinoma represents a serious complication of primary sclerosing cholangitis. Ursodeoxycholic acid may possibly influence the incidence of cholangiocarcinoma in man. The aim of this study was to evaluate the incidence rate of cholangiocarcinoma in a large group of primary sclerosing cholangitis patients after long-time treatment with ursodeoxycholic acid.From May 1987 up to May 2005 a total of 150 patients with primary sclerosing cholangitis but without evidence of cholangiocarcinoma at entry were included in the study. All patients were treated with ursodeoxycholic acid and controls were performed in at least yearly intervals.The median treatment time of the 150 patients was 6.4 years. Altogether five patients developed a cholangiocarcinoma during treatment yielding a rate of 3.3%. The patients developed 0.58 cholangiocarcinoma per 100 patient-years in years 0-2.5, 0.59 cholangiocarcinoma in years 2.5-8.5, and no cholangiocarcinoma thereafter up to 18 years after entry into the study. The Kaplan-Meier estimate of cholangiocarcinoma incidence during ursodeoxycholic acid treatment reached a plateau after 8.3 years.The annual incidence rate of cholangiocarcinoma in primary sclerosing cholangitis treated with ursodeoxycholic acid is lower than expected and decreases with time of treatment.
Ursodeoxycholic acid
Primary Sclerosing Cholangitis
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Ursodeoxycholic acid
Primary Sclerosing Cholangitis
Primary (astronomy)
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Background: Ursodeoxycholic acid absorption in the proximal intestine may be impaired in patients with inflammatory bowel disease. Methods: We examined the intestinal absorption of ursodeoxycholic acid by the oral ursodeoxycholic acid tolerance test in 19 children and adolescents with inflammatory bowel disease at various stages, including 8 patients with unoperated Crohn's disease, 3 patients with ileal-resected Crohn's disease, 8 with ulcerative colitis, and 8 healthy control subjects. Results: Ursodeoxycholic acid malabsorption was present in all patients with unoperated Crohn's disease in the first diagnosed active stage, in 3 of 5 patients in a relapsing active stage, and in 2 of 8 patients in remission. Ursodeoxycholic acid absorption was significantly lower in patients in the first diagnosed active stage than in the healthy controls (p < 0.01) or in patients in remission (p < 0.01). There was no significant difference between healthy controls and the patients in a relapsing active stage or in remission. Ursodeoxycholic acid absorption was abnormal during the first postoperative month in patients with ileal-resected Crohn's disease, but normalized over time. Malabsorption of ursodeoxycholic acid was not observed in any patients with ulcerative colitis. Conclusions: These findings suggest that absorption of ursodeoxycholic acid in the proximal intestine is impaired in patients with Crohn's disease and that the oral ursodeoxycholic acid tolerance test is a convenient and useful means of evaluating the absorption of bile acid in the proximal intestine in pediatric patients with ileal or ileocolic Crohn's disease.
Ursodeoxycholic acid
Bile acid malabsorption
Pouchitis
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Ursodeoxycholic acid treatment used in the management of primary sclerosing cholangitis leads to a rapid improvement in liver enzymes and is well tolerated in most patients. Fatigue and pruritus also showed an improvement, even if not significant compared with placebo, in some 50% of cases. Results of the investigations also showed that liver transplantation may be postponed in primary sclerosing cholangitis treated with ursodeoxycholic acid.
Ursodeoxycholic acid
Primary Sclerosing Cholangitis
Liver enzyme
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Surgical margin
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Primary sclerosing cholangitis(PSC) is an unexplained cholestatic liver disease,and genetic predisposition and environmental factors are possibly responsible for it.Ursodeoxycholic acid(UDCA)is beneficial for cholestatic liver diseases.In primary sclerosing cholangitis(PSC),evidences show that high doses(±20 mg/kg)of UDCA may be more effective than average doses.This article reports on the clinical effect of UDCA in the treatment of PSC with analysis based on literature.
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Primary Sclerosing Cholangitis
Genetic predisposition
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