The presence of concomitant primary sclerosing cholangitis with inflammatory bowel disease represents a distinct disease phenotype that carries a higher risk of colorectal cancer than the average inflammatory bowel disease patient.
Liver transplantation is the only treatment that offers a survival benefit in primary sclerosing cholangitis patients with hepatic dysfunction.
Dr Kris Kowdley
and colleagues from Washington, USA explored management decisions in inflammatory bowel disease patients’ post-liver transplantation for primary sclerosing cholangitis that are frequently encountered.
One such consideration is the risk of colorectal cancer in this immunosuppressed cohort.
|Annual surveillance colonoscopy after liver transplant is recommended for primary sclerosing cholangitis-IBD patients|
|Inflammatory Bowel Diseases|
With most studies showing an increased risk of colorectal cancer post-liver transplantation in these inflammatory bowel disease patients, a closer look at the associated risk factors of colorectal cancer and the adopted surveillance strategies in this subset of patients is warranted.
The research team found that low-dose ursodeoxycholic acid has shown a potential chemopreventive effect in primary sclerosing cholangitis-inflammatory bowel disease patients pre-liver transplantation; however, a favorable effect remains to be seen in post-liver transplantation group.
Further studies are necessary to assess the benefit of 5 aminosalicylate therapy.
Dr Kowdley's team summarises,"Annual surveillance colonoscopy in the post-liver transplantation period is recommended for primary sclerosing cholangitis-inflammatory bowel disease patients subset given their high risk for colorectal cancer."