Cases of Primary Sclerosing Cholangitis Rising Across North America

The incidence and prevalence of primary sclerosing cholangitis (PSC) appears to be increasing across North America and Europe, suggest results from a systematic review published in Clinical Gastroenterology and Hepatology.

“Primary sclerosing cholangitis will continue to challenge clinicians and health policy makers,” wrote lead study author Palak J. Trivedi, MD, of the University of Birmingham Center for Liver and Gastroenterology Research in England, and coauthors. “Health care services must adapt their gastroenterology and hepatology infrastructure to manage this complex and costly disease.”

The review included 17 published population-based studies. Among them, 16 documented the incidence, and 14 documented the prevalence, of PSC.

Incidence was highest in North America (1.47 per 100,000 in Minnesota) and Northern Europe  (1.58 per 100,000 in Finland and 1.3 per 100,000 in Norway). On the other end of the spectrum, the Mediterranean Basin showed the lowest incidence (0.1 per 100,000 in Italy), according to the review. Prevalence was highest in Finland (31.7 per 100,000) and Minnesota (23.9 per 100,000), and lowest in Singapore (1.33 per 100,000) and Alaska (0.0 per 100,000).

Studies that looked at temporal occurrence showed a rise in both incidence and prevalence throughout North America and Northern Europe, researchers reported.

Median transplant-free survival in patients with the disease ranged from 9.7 years in the United States to 20.6 years in the Netherlands, and standardized mortality ratios for patients compared with control populations ranged from 2.5 in the United States to 4.2 in the Netherlands. The standardized incidence ratio of cholangiocarcinoma, according to the review, ranged from 235 in Finland to 398 in the Netherlands compared with healthy controls.

“Ultimately,” researchers advised, “the recognition of risk factors for, and changing patterns of disease, will prove important to the ongoing goal of heightened disease awareness, accurate diagnosis, and targeted care.”

—Jolynn Tumolo

Reference:
Trivedi PJ, Bowlus CL, Yimam KK, Razavi H, Estes C. Epidemiology, natural history, and outcomes of primary sclerosing cholangitis: a systematic review of population-based studies. Clin Gastroenterol Hepatol. 2022;20(8):1687-1700.e4.