You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Effect of Ursodeoxycholic Acid Use on the Risk of Colorectal Neoplasia in Patients with Primary Sclerosing Cholangitis and Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Singh, Siddharth MD; Khanna, Sahil MBBS; Pardi, Darrell S. MD, MS; Loftus, Edward V. Jr MD; Talwalkar, Jayant A. MD, MPH

Inflammatory Bowel Diseases:
doi: 10.1097/MIB.0b013e318286fa61
Original Clinical Articles
Abstract

Background: Ursodeoxycholic acid (UDCA) may modify the risk of inflammatory bowel disease (IBD)–associated colorectal cancer. We performed a systematic review and meta-analysis of studies evaluating the effect of UDCA on the risk of IBD-associated colorectal neoplasia (CRN) (defined as colorectal cancer and/or dysplasia) in patients with primary sclerosing cholangitis with concomitant IBD (PSC-IBD).

Methods: We conducted a systematic search of Medline, Embase, and Web of Science and manually reviewed the literature. Studies were included if they: (1) evaluated exposure to UDCA in patients with PSC-IBD, (2) reported IBD-associated CRN as outcome, and (3) reported relative risks or odds ratios (ORs) or provided data for their calculation. Summary OR estimates with 95% confidence intervals (CIs) were calculated using the random-effects model.

Results: Eight studies (5 observational, 3 randomized controlled trials) reporting 177 cases of CRN in 763 patients with PSC-IBD were included in the analysis. Overall, meta-analysis showed no significant protective association between UDCA use and CRN (OR, 0.81; 95% CI, 0.41–1.61). However, there was a significant chemopreventive effect on the risk of advanced CRN (colorectal cancer and/or high-grade dysplasia) (OR, 0.35; 95% CI, 0.17–0.73). In a subgroup analysis, low-dose UDCA use (8–15 mg/kg/d) was associated with significant risk reduction of CRN (OR, 0.19; 95% CI, 0.08–0.49).

Conclusions: UDCA, particularly at low doses, may reduce the risk of advanced CRN in patients with PSC-IBD. However, results should be interpreted with caution, given limited reporting of cancer-related outcomes, primarily from tertiary care centers.

In Brief

Article first published online 9 May 2013

Author Information

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Reprints: Jayant A. Talwalkar, MD, MPH, 200 First Street SW, Rochester, MN 55905 (e-mail: talwalkar.jayant@mayo.edu).

The authors have no conflicts of interest to disclose.

Received October 12, 2012

Accepted January 9, 2013

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

You currently do not have access to this article.

You may need to:

Note: If your society membership provides for full-access to this article, you may need to login on your society’s web site first.