A recent study (A Ricciuto et al. Clin Gastroenterol Hepatol 2018; 16: 1098-1105) provides more data regarding the lack of symptom correlation and inflammatory bowel disease (IBD) activity in children with primary sclerosing cholangitis (PSC).
In a prospective study of children with colonic IBD with and without PSC, the authors followed clinical features (eg. PUCAI), fecal calprotectin and endoscopy severity.
- Patients with PSC-IBD (n=37) in clinical remission had higher endoscopic scores and greater odd of active endoscopic disease than IBD-only controls (n=50) (odds ratio 5.9, with CI 1.6-21.5)
- Fecal calprotectin level <93 mcg/g were identified mucosal healing with 100% sensitivity and 92% specificity when compared with UC Endoscopic Index of Severity (UCEIS)
Overall, this study is in agreement with a prior adult study showing higher levels of active disease in those with PSC-IBD compared to those with IBD alone, despite clinical remission (Why does PSC increase the risk of colorectal cancer in UC?).
My take: Particularly in individuals with the combination of IBD-PSC, objective biomarkers (eg. Calprotectin) are needed to identify the accuracy of clinical remission; though, even in patients with IBD without PSC, objective biomarkers are needed as well due to the limitations of clinical symptom indices.
Related blog posts:
Pingback: Ursodeoxycholic Acid in Pediatric Primary Sclerosing Cholangitis | gutsandgrowth
Pingback: Easy Advice for Pediatric Hepatologists: PSC Surveillance Recommendations | gutsandgrowth
Pingback: Development of Primary Sclerosing Cholangitis in Pediatric Patients with Inflammatory Bowel Disease | gutsandgrowth
Pingback: Online Aspen Webinar (Part 3) -Primary Sclerosing Cholangitis | gutsandgrowth
Pingback: IBD Update -September 2020 | gutsandgrowth
Pingback: How Primary Sclerosing Cholangitis Alters Outcomes in Inflammatory Bowel Disease | gutsandgrowth
Pingback: Recurrent PSC in Children After Liver Transplantation | gutsandgrowth
Pingback: Long-Term Outcomes of Pediatric Patients with Sclerosing Cholangitis in the Setting of Inflammatory Bowel Disease | gutsandgrowth
Pingback: PSC in IBD | gutsandgrowth