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Ursodiol Reduces Colonic Dysplasia in Patients with Ulcerative Colitis and Primary Sclerosing Cholangitis

Patients with both ulcerative colitis and primary sclerosing cholangitis (PSC) are at particularly high risk for colon cancer. Ursodiol is used often to treat patients with PSC because it improves liver function; it also has been shown to have a chemoprotective effect against colon cancer in animals. To examine the association between ursodiol and colonic dysplasia, researchers studied 59 patients with ulcerative colitis and PSC who were enrolled in a colonoscopic surveillance program: 41 were prior users of ursodiol, and 18 were not.

Ursodiol users were significantly less likely to develop dysplasia than were nonursodiol users (odds ratio, 0.18); the decreased risk persisted after adjustment for sex, age of onset of ulcerative colitis, duration of ulcerative colitis, duration of PSC, Child-Pugh class, and use of sulfasalazine. The OR for development of high-grade dysplasia in ursodiol users was 0.17.

Comment: Although the significance of these results is limited by the study's retrospective design, both the benign nature of ursodiol treatment and its possible benefits in patients with PSC suggest that patients with ulcerative colitis and PSC should receive ursodiol. However, the drug is expensive, and it is too early to be sure of its clinical efficacy. The authors recommend a randomized, controlled trial of ursodiol for preventing colonic neoplasia in patients with ulcerative colitis and PSC.

— DK Rex

Published in Journal Watch Gastroenterology February 26, 2001

Citation(s):

Tung BY et al. Ursodiol use is associated with lower prevalence of colonic neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis. Ann Intern Med 2001 Jan 16 134 89-95.

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