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.
Article first published online 9 May 2013
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Reprints: Jayant A. Talwalkar, MD, MPH, 200 First Street SW, Rochester, MN 55905 (e-mail: firstname.lastname@example.org).
The authors have no conflicts of interest to disclose.
Received October 12, 2012
Accepted January 9, 2013