Prevalence and Outcomes of Primary Sclerosing Cholangitis in Inflammatory Bowel Disease: A Multinational Study across Asia

Background and aims Primary sclerosing cholangitis (PSC) frequently coexists with inflammatory bowel disease (IBD). PSC is a progressive disease that may lead to end-stage liver failure requiring liver transplantation (LT). Although PSC-IBD has been extensively studied in Western populations, data from Asia remain limited. We conducted an international multicenter study across Asia to investigate the prevalence of PSC in IBD patients and evaluate its impact on clinical outcomes. Methods This retrospective cohort study included IBD patients from 25 hospitals in six Asian countries. The primary endpoint was the prevalence of PSC in IBD patients. The secondary endpoints included the incidence of colorectal neoplasia and IBD-related surgery following IBD diagnosis, and the occurrence of cholangiocarcinoma (CCA), LT, and death after PSC diagnosis among PSC-IBD patients. Temporal trends were assessed across five diagnostic eras of PSC. Results Among 51,314 IBD patients, 474 had PSC (0.92%), with a prevalence of 1.4% in ulcerative colitis and 0.13% in Crohn’s disease. Among 375 Asian PSC-IBD patients, 9.1% developed colorectal neoplasia, 7.2% developed CCA, 24% underwent LT, and 16% died. In more recent diagnostic eras, patients presented with fewer symptoms, lower alkaline phosphatase levels, and better liver function scores. The use of magnetic resonance cholangiopancreatography (MRCP) has increased over time. Symptomatic PSC and low serum albumin were significantly associated with a shorter time to LT, which was significantly longer in recent eras ( P = 0.016). Conclusion PSC is less prevalent among Asian IBD patients than in Western populations. The increased use of MRCP may enable earlier detection, contributing to milder disease severity and improved clinical outcomes in recent years.