Sclerosing cholangitis, race and sex

Background—Primary sclerosing cholangitis developsin 3-10% of patients with ulcerative colitis, and may be associatedwith an increased cancer risk. Ulcerative colitis is probably less common in people of African origin than in populations of European descent.
Aims and methods—To review the records of allpatients under regular follow up for ulcerative colitis at StBartholomew's Hospital (London, UK) , a tertiary referral centre,prompted by discovering a cluster of cases with common features.
Results and conclusions—Among 166 patients withulcerative colitis under regular follow up, only four (all women) areof African or Caribbean genetic origin, and three of these havedeveloped sclerosing cholangitis within three years of presentationwith colitis, compared with four of 162 patients of European or Asian descent (odds ratio 119, 95% confidence interval 8-3837; p=0.0002). This cluster, which is not explained by common HLA DR or DQ type, suggests that Africans and Afro-Caribbeans, especially women, may be atincreased risk of sclerosing cholangitis. This may reflect geneticinfluences on the development of enteric and hepatobiliary inflammatory disease.

Keywords:sclerosing cholangitis; ulcerative colitis; geneticsof inflammatory bowel disease; racial effects on disease