Prevalence of digestive cancers in inflammatory bowel diseases associated with primary sclerosing cholangitis

Introduction: Primary sclerosing cholangitis (PSC) is a rare inflammatory and fibrosing disease of the bile ducts, frequently associated with inflammatory bowel disease (IBD), and conferring an increased risk of cholangiocarcinoma and colorectal cancer (CRC).

Objective: To determine the prevalence of digestive cancers in IBD associated with PSC in a Moroccan hospital center.

Methods: A retrospective, descriptive, single-center study conducted between July 2018 and July 2023. All patients with IBD and PSC confirmed by MRCP were included. Clinical, biological, endoscopic, and follow-up data were analyzed.

Results: Among 424 IBD patients, 3 had associated PSC (prevalence: 0.70%), with a mean age of 37.3 years and a male-to-female ratio of 2. There was one case of ulcerative colitis (UC) and two cases of Crohn’s disease (CD). PSC was always diagnosed after IBD (mean delay: 4.5 years for CD, 20 years for UC). All patients received ursodeoxycholic acid (UDCA) in combination with specific treatment for IBD. Screening colonoscopies for CRC were normal. One patient (UC) developed distal cholangiocarcinoma and died after surgical treatment.

Conclusion: Although rare, the IBD–PSC association warrants annual colonoscopic surveillance and regular screening for cholangiocarcinoma due to the high oncological risk.