The Natural History of Primary Sclerosing Cholangitis in Children
- 1 December 2016
- journal article
- research article
- Published by Wiley in Journal of Pediatric Gastroenterology and Nutrition
- Vol. 63 (6), 603-609
- https://doi.org/10.1097/mpg.0000000000001368
Abstract
Objectives: Data regarding pediatric primary sclerosing cholangitis (PSC) natural history are limited. We describe a large pediatric PSC cohort with longitudinal follow-up. Methods: The present study records review of pediatric patients with PSC diagnosed between 1984 and 2014. Results: N = 120 (63% M) ages 1 to 21 years (median 14 years) at diagnosis. 27% (31/113) had autoimmune sclerosing cholangitis (ASC), 24% had exclusive small duct PSC, METAVIR stage was F3-F4 in 41%. Eighty-one percent of patients with PSC had inflammatory bowel disease (IBD); most had ulcerative/indeterminate colitis (72/97), typically pancolitis (40/72). PSC-IBD was more common than ASC-IBD (85% vs 68%, P = 0.03). Median follow-up was 3.7 years (interquartile range [IQR] 1.5, 6.9). Median gamma glutamyl transferase decreased from baseline of 221 U/L (IQR 110, 425) to 104 U/L by 1 year postdiagnosis ([IQR 18,229], P < 0.0001), and then changed little. Mean fibrosis stage at diagnosis was 2.3 ± 1.4 (N = 91), and at 1 to 5 years was 2.6 ± 1.3 (N = 20). Transplant-free survival at 10 year was 89%; there were 6 liver transplants, 2 in patients with small duct PSC and 4 with diffuse large duct PSC. Although the cirrhosis rate was not significantly different in PSC with IBD versus without (22% vs 41%, P = 0.06), the former had a lower rate of liver transplantation (2% vs 18%, P = 0.01). The rate of cirrhosis was lower in patients diagnosed with IBD before PSC (15% vs 31%, P = 0.05). Conclusions: In this largest reported pediatric PSC cohort, liver transplantation rate at 10 years was lower than that reported in adults. ASC and PSC had similar biochemical abnormalities and degree of fibrosis at diagnosis. PSC that developed after IBD diagnosis had a milder course, possibly reflecting earlier disease detection or milder phenotype.Keywords
This publication has 12 references indexed in Scilit:
- Pediatric Medical Complexity Algorithm: A New Method to Stratify Children by Medical ComplexityPediatrics, 2014
- 2014 Recommendations for Pediatric Preventive Health CarePublished by American Academy of Pediatrics (AAP) ,2014
- Update on inflammatory bowel disease in patients with primary sclerosing cholangitisWorld Journal of Hepatology, 2014
- Primary sclerosing cholangitis, autoimmune hepatitis, and overlap in utah children: Epidemiology and natural historyHepatology, 2013
- Bile acid changes after high-dose ursodeoxycholic acid treatment in primary sclerosing cholangitis: Relation to disease progressionHepatology, 2010
- A Retrospective Single-Center Review of Primary Sclerosing Cholangitis in ChildrenClinical Gastroenterology and Hepatology, 2009
- Primary Sclerosing Cholangitis in Children: A Histologic Follow-up StudyPediatric and Developmental Pathology, 2005
- Primary sclerosing cholangitis in children: A long-term follow-up studyHepatology, 2003
- Autoimmune hepatitis/sclerosing cholangitis overlap syndrome in childhood: A 16-year prospective studyHepatology, 2001
- Primary sclerosing cholangitis in 32 children: Clinical, laboratory, and radiographic features, with survival analysisHepatology, 1995