Ursodiol for All?

Lee, Scott D.; Surawicz, Christina M.
December 2001
American Journal of Gastroenterology;Dec2001, Vol. 96 Issue 12, p3437
Academic Journal
The authors undertook retrospective cross-sectional study to determine the relationship between the use of ursodiol and dysplasia in patients with ulcerative colitis and primary sclerosing cholangitis (PSC). All patients with ulcerative colitis and PSC were evaluated for the presence of dysplasia in biopsies taken during a previously established colonoscopic surveillance program. In the program, patients underwent colonoscopy every 3 yr with random four-quadrant biopsies (average of 47 biopsies/session). If low grade dysplasia indefinite for dysplasia or aneuploidy was found at any time, patients then had yearly colonoscopies. Patients were included in the ursodiol group if they had used ursodiol at any time before the development of dysplasia. The primary endpoint was the development of dysplasia. Fifty-nine patients met the entry criteria. Of these, 41 had taken ursodiol at some time and 18 had never taken ursodiol. The development of dysplasia was significantly less common in patients who had received ursodiol (odds ratio = 0.18, 95% CI = 0.05-0.61). The development of dysplasia was not related to other medications, including sulfasalazine, 5-aminosalicylic acid, prednisone, cyclosporine, azathioprine, and methotrexate. The protective effect of ursodiol against the development of dysplasia remained after adjusting for sex, age at onset of colitis, duration of colitis, duration of PSC, Child-Pugh class, and use of sulfasalazine. An increased risk for the development of dysplasia was also noted in those patients who had onset of colitis at a younger age. The authors concluded that ursodiol use is associated with lower frequency of colonic dysplasia in patients with ulcerative colitis and PSC. They suggest that a prospective randomized trial evaluating the chemoprotective effect of ursodiol is warranted.


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