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Does colectomy affect the progression of primary sclerosing cholangitis? A systematic review and meta-analysis

AIM: The aim of this systematic review was to determine if the human colon, through the lower gut-liver axis, drives PSC activity by assessing the progression of the disease in patients with and without colectomy for colonic disease. BACKGROUND: The gut-liver axis is involved in the pathogenesis of...

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Autores principales: Ong, John, Bath, Michael F., Swift, Carla, Al-Naeeb, Yasseen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Shaheed Beheshti University of Medical Sciences 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204254/
https://www.ncbi.nlm.nih.gov/pubmed/30425805
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author Ong, John
Bath, Michael F.
Swift, Carla
Al-Naeeb, Yasseen
author_facet Ong, John
Bath, Michael F.
Swift, Carla
Al-Naeeb, Yasseen
author_sort Ong, John
collection PubMed
description AIM: The aim of this systematic review was to determine if the human colon, through the lower gut-liver axis, drives PSC activity by assessing the progression of the disease in patients with and without colectomy for colonic disease. BACKGROUND: The gut-liver axis is involved in the pathogenesis of liver disease. Abnormal immune-mediated responses to intestinal microbiome are implicated in primary sclerosing cholangitis (PSC) however the mechanisms remain poorly understood. Currently, no single animal model recapitulates all attributes of PSC in humans and this limits further studies of gut-liver interactions. METHODS: A systematic search of PubMed, Medline, and Scopus was performed for articles that contained the terms “colectomy” or “bowel resection” AND “primary sclerosing cholangitis” up to 15th April 2018. Articles were reviewed by 2 reviewers and raw data collated. A Forest plot was used to illustrate the effect of colectomy on subsequent liver transplantation for PSC. Linear regression was used to estimate mortality risk. RESULTS: Colectomy appeared to have no effect on PSC progression, although high-quality studies were lacking. Rates of liver transplantation or transjugular intrahepatic portosystemic shunt for PSC were not affected by colectomy (OR 0.59, 95% CI 0.14 - 2.53, p=0.48). Mortality risk following colectomy in patients with PSC is 2.11% per year (95% CI 0.03% - 4.18%, p=0.032, R2 = 0.722). CONCLUSION: Current evidence is limited but suggests colectomy does not affect the progression of PSC in patients with colonic disease. Pathogenic micro-organisms or antigens that drive PSC may not be limited to the lower gut.
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spelling pubmed-62042542018-11-13 Does colectomy affect the progression of primary sclerosing cholangitis? A systematic review and meta-analysis Ong, John Bath, Michael F. Swift, Carla Al-Naeeb, Yasseen Gastroenterol Hepatol Bed Bench Systematic Review AIM: The aim of this systematic review was to determine if the human colon, through the lower gut-liver axis, drives PSC activity by assessing the progression of the disease in patients with and without colectomy for colonic disease. BACKGROUND: The gut-liver axis is involved in the pathogenesis of liver disease. Abnormal immune-mediated responses to intestinal microbiome are implicated in primary sclerosing cholangitis (PSC) however the mechanisms remain poorly understood. Currently, no single animal model recapitulates all attributes of PSC in humans and this limits further studies of gut-liver interactions. METHODS: A systematic search of PubMed, Medline, and Scopus was performed for articles that contained the terms “colectomy” or “bowel resection” AND “primary sclerosing cholangitis” up to 15th April 2018. Articles were reviewed by 2 reviewers and raw data collated. A Forest plot was used to illustrate the effect of colectomy on subsequent liver transplantation for PSC. Linear regression was used to estimate mortality risk. RESULTS: Colectomy appeared to have no effect on PSC progression, although high-quality studies were lacking. Rates of liver transplantation or transjugular intrahepatic portosystemic shunt for PSC were not affected by colectomy (OR 0.59, 95% CI 0.14 - 2.53, p=0.48). Mortality risk following colectomy in patients with PSC is 2.11% per year (95% CI 0.03% - 4.18%, p=0.032, R2 = 0.722). CONCLUSION: Current evidence is limited but suggests colectomy does not affect the progression of PSC in patients with colonic disease. Pathogenic micro-organisms or antigens that drive PSC may not be limited to the lower gut. Shaheed Beheshti University of Medical Sciences 2018 /pmc/articles/PMC6204254/ /pubmed/30425805 Text en ©2018 RIGLD, Research Institute for Gastroenterology and Liver Diseases This is an Open Access article distributed under the terms of the Creative Commons Attribution License, (http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Systematic Review
Ong, John
Bath, Michael F.
Swift, Carla
Al-Naeeb, Yasseen
Does colectomy affect the progression of primary sclerosing cholangitis? A systematic review and meta-analysis
title Does colectomy affect the progression of primary sclerosing cholangitis? A systematic review and meta-analysis
title_full Does colectomy affect the progression of primary sclerosing cholangitis? A systematic review and meta-analysis
title_fullStr Does colectomy affect the progression of primary sclerosing cholangitis? A systematic review and meta-analysis
title_full_unstemmed Does colectomy affect the progression of primary sclerosing cholangitis? A systematic review and meta-analysis
title_short Does colectomy affect the progression of primary sclerosing cholangitis? A systematic review and meta-analysis
title_sort does colectomy affect the progression of primary sclerosing cholangitis? a systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204254/
https://www.ncbi.nlm.nih.gov/pubmed/30425805
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