Ursodiol use is associated with lower prevalence of colonic neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis

Background: Patients with ulcerative colitis and primary sclerosing cholang itis are at high risk for colonic dysplasia and cancer. This risk approache s 50% after 25 years of colitis. Ursodiol has been shown to protect against development of colorectal neoplasia in animal models. Objective: To assess the relationship between ursodiol use and colonic dysp lasia, the precursor to colon cancer, in patients with ulcerative colitis a nd primary sclerosing cholangitis. Design: Cross-sectional study. Setting: University medical center. Patients: 59 patients with ulcerative colitis and primary sclerosing cholan gitis who were undergoing colonoscopic surveillance for colonic dysplasia. Measurements: Use of ursodiol was assessed in all patients. The presence or absence of colonic dysplasia was evaluated by colonoscopic surveillance. O ther variables assessed were age at onset and duration of ulcerative coliti s; duration of primary sclerosing cholangitis; Child-Pugh classification; a nd use of sulfasalazine, other 5-aminosalicylic acid preparations, predniso ne, cyclosporine, azathioprine, and methotrexate. Results: Ursodiol use was strongly associated with decreased prevalence of colonic dysplasia (odds ratio, 0.18 [95% CI, 0.05 to 0.61]; P = 0.005). The association between dysplasia and ursodiol use remained after adjustment f or sex, age at onset of colitis, duration of colitis, duration of sclerosin g cholangitis, severity of liver disease, and sulfasalazine use (adjusted o dds ratio, 0.14 [Cl, 0.03 to 0.64]; P = 0.01). Younger age at onset of coli tis was associated with an increased risk for dysplasia. Conclusions: Ursodiol use appears to be associated with a lower frequency o f colonic dysplasia in patients with ulcerative colitis and primary scleros ing cholangitis. A randomized trial investigating the chemoprotective effec t of ursodiol in patients with ulcerative colitis may be warranted.