Ursodiol Is Associated with Fewer Precancerous Abnormalities of the Colon in Certain Patients with Ulcerative Colitis

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The summary below is from the full report titled "Ursodiol Use Is Associated with Lower Prevalence of Colonic Neoplasia in Patients with Ulcerative Colitis and Primary Sclerosing Cholangitis." It is in the 16 January 2001 issue of Annals of Internal Medicine (volume 134, pages 89-95). The authors are BY Tung, MJ Emond, RC Haggitt, MP Bronner, MB Kimmey, KV Kowdley, and TA Brentnall.

What is the problem and what is known about it so far?

Ulcerative colitis (UC) is a disease in which chronic inflammation of the colon leads to diarrhea, bleeding into the stool, abdominal pain, difficulties with nutrition, and an increased risk for colon cancer. Primary sclerosing cholangitis (PSC) is an inflammatory disease of the biliary tract, the system that brings bile from the liver to the gut. Approximately 2% to 4% of patients with UC also have PSC. Nearly half of patients with both UC and PSC will develop colon cancer or precancerous changes of the colon (dysplasia) within 25 years of diagnosis of UC. This risk for cancer is so high that some patients are willing to have their colons removed surgically as a preventive measure. Strategies to decrease the risk for colon cancer, other than removal of the colon, could benefit patients with both UC and PSC. Ursodiol is a drug that has been useful in treating liver abnormalities in patients with PSC. Ursodiol decreases the amount of bile acids that reach the colon; this is important because bile acids may play a role in the development of colon cancer.

Why did the researchers do this particular study?

To find out whether patients with UC and PSC who receive ursodiol are less likely to develop colon cancer or precancerous changes of the colon than those who do not.

Who was studied?

Fifty-nine patients with UC and PSC who received care in a teaching hospital.

How was the study done?

The researchers determined whether patients were taking ursodiol and collected information about their medical histories. All of the patients had a procedure that examined the inside of the colon (colonoscopy) every 1 to 3 years to look for cancer or precancerous changes.

What did the researchers find?

Patients who took ursodiol were less likely to develop colon cancer or precancerous changes than those who did not. This relationship remained even after accounting for the patients' age, duration of UC and PSC, severity of liver disease, and use of other medications.

What were the limitations of the study?

It is unclear whether similar results would occur in patients who have UC only. The decision to treat with ursodiol was made by patients' individual doctors rather than as part of a randomized study. Patients who received ursodiol may therefore have differed from those who did not in ways that the researchers could not account for.

What are the implications of the study?

Patients with UC and PSC who take ursodiol appear less likely to develop cancer or precancerous changes of the colon than those who do not take ursodiol. A randomized trial should be done to determine whether ursodiol is effective prevention for colon cancer in patients with UC.