Published online Jul 28, 2020. doi: 10.3748/wjg.v26.i28.4126
Peer-review started: March 30, 2020
First decision: April 25, 2020
Revised: June 8, 2020
Accepted: July 15, 2020
Article in press: July 15, 2020
Published online: July 28, 2020
Core tip: This is a retrospective study evaluating biopsies and clinical features of primary sclerosing cholangitis (PSC) patients with and without inflammatory bowel disease (IBD) in comparison to subjects with ulcerative colitis (UC) or Crohn disease (CD). Patients with PSC-UC had a different disease distribution characterized by right sided colitis, a milder disease course with lower activity scores in biopsies, less need for colectomy, and less steroids compared to UC. PSC-CD patients were rare but had more ileal inflammation compared to PSC-UC. PSC-No IBD patients showed similar characteristics to PSC patients in general and only one patient received orthotopic liver transplantation (OLT) in this group. Ten PSC-UC patients received OLT in contrast to no patients with PSC-CD. The need for OLT in PSC-IBD (PSC-UC and PSC-CD) correlated with rectal involvement and higher activity scores in the left colon biopsies in comparison to patients without OLT. This may require clinical attention since the both the intestinal and liver disease seem to be “severe” in this group further supporting the importance of gut-liver interaction in these patients.