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Does primary sclerosing cholangitis impact quality of life in patients with inflammatory bowel disease?

Ananthakrishnan, Ashwin N. MD, MPH1; Beaulieu, Dawn B. MD1; Ulitsky, Alex MD1; Zadvornova, Yelena MD1; Skaros, Sue PA-C1; Johnson, Kathryn PA-C1; Naik, Amar MD1; Perera, Lilani MD1; Issa, Mazen MD1; Binion, David G. MD2; Saeian, Kia MD, MSc Epi1,*

doi: 10.1002/ibd.21051
Original Clinical Articles

Background: Impairment of health-related quality of life (HRQoL) is an important concern in inflammatory bowel disease (IBD; ulcerative colitis [UC], Crohn's disease [CD]). Between 2%–10% of patients with IBD have primary sclerosing cholangitis (PSC). There has been limited examination of the disease-specific HRQoL in this population compared to non-PSC IBD controls.

Methods: This was a retrospective, case–control study performed at a tertiary referral center. Cases comprised 26 patients with a known diagnosis of PSC and IBD (17 UC, 9 CD). Three random controls were selected for each case after matching for IBD type, gender, age, and duration of disease. Disease-specific HRQoL was measured using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Disease activity for CD was measured using the Harvey–Bradshaw index (HB) and using the UC activity index for UC. Independent predictors of HRQoL were identified.

Results: There was no significant difference in the age, gender distribution, or disease duration between PSC-IBD and controls. There was no difference in use of immunomodulators or biologics between the 2 groups. Mean SIBDQ score was comparable between PSC-IBD patients (54.5) and controls (54.1), both for UC and CD. Likewise, the disease activity scores were also similar (2.8 versus 3.1, P = 0.35). On multivariate analysis, higher disease activity score (−1.33, 95% confidence interval [CI] 95% CI −1.85 to −0.82) and shorter disease duration were predictive of lower HRQoL. Coexisting PSC did not influence IBD-related HRQoL. There was a higher proportion of permanent work disability in PSC-IBD (7.7%) compared to controls (0%).

Conclusions: PSC does not seem to influence disease-specific HRQoL in our patients with IBD but is associated with a higher rate of work disability. (Inflamm Bowel Dis 2010)

1Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin

2Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

*Reprints: Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53227


Received for publication 12 May 2009; Accepted 16 June 2009.

Published online 27 July 2009 in Wiley InterScience (

© Crohn's & Colitis Foundation of America, Inc.
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