How Common Is Liver Disease In People With Ulcerative Colitis?

This Liver Disease Is Associated With Inflammatory Bowel Disease

Doctor Explaining Liver
If you develop liver disease, you will need a multi-specailty team to care for your needs. Image © Jeannot Olivet / E+ / Getty Images

Inflammatory bowel disease (IBD) is associated with several other conditions, including the liver disease primary sclerosing cholangitis (PSC). PSC is generally linked with ulcerative colitis, although it can also be found in people who have Crohn's disease. The risk of PSC is very low for people with IBD, but it is still important to know that the two conditions are linked. If you have questions about your risk of PSC, talk to your physician.

What Is PSC?

PSC causes the bile ducts inside and outside of the liver to narrow and become inflamed. It's unknown what causes PSC, but it is considered to be an autoimmune disease. There is a genetic component to PSC, with first-degree relatives of those with PSC having a 100-fold increased risk.

To find out more about how these two conditions are related, I turned to UpToDate, a resource for physicians and patients looking for in-depth medical information. After reading the excerpt, continue on for an explanation of what all of this means for you.

"[ulcerative colitis] UC has been reported in 25% to 90% of patients with PSC. A survey of 23 hospitals in Spain, for example, examined the reported cases of PSC from 1984 to 1988; UC was present in 44%. It is likely that this figure is an underestimate, since the colonic mucosa may be grossly normal in appearance despite the presence of histologic colitis. The true prevalence of UC in PSC is probably closer to 90% when rectal and sigmoid biopsies are routinely obtained.
"There are varying reports of the prevalence of PSC in UC. A survey of 1500 patients with UC in Sweden, for example, found that 72 (5%) had an elevated serum alkaline phosphatase; endoscopic retrograde cholangiopancreatography (ERCP) was performed in 65, of whom 55 (85%) had evidence of PSC [9]. PSC was more prevalent in patients with pancolitis than in those with distal colitis (5.5% versus 0.5%). It was also more common in men than women. Another report found that more than 7% of patients with UC may have PSC."

What Are the Chances I Will Develop PSC if I Have Ulcerative Colitis?

It is estimated that about 5% of people who have ulcerative colitis will develop PSC. If the ulcerative colitis is limited to the left side of the colon (the rectum, sigmoid colon, and descending colon), the chances of developing PSC are less. PSC is more common, however, in those who have ulcerative colitis throughout the entire colon (known as pancolitis).

If I Have PSC, What Are the Chances I Also Have Ulcerative Colitis?

It's not certain. It is still unclear how common ulcerative colitis is in those who have PSC for a few reasons. The first is that different studies on the link between the two diseases have shown variable results -- anywhere from 25% to 90%. The second is that these studies might not give accurate estimates of how many people have both ulcerative colitis and PSC.

It is possible to actually have ulcerative colitis, even if the colon looks normal upon a doctor's examination. Because of this, it is possible that some studies are underestimating the percentage of people with PSC who also have ulcerative colitis. Therefore, it is thought that the percentage of PSC patients who also have ulcerative colitis could actually be as high as 90%.

Want to learn more? See UpToDate's topic, "Epidemiology and pathogenesis of primary sclerosing cholangitis," for additional in-depth medical information.


Tung, Bruce Y. Kowdley, Kris V. "Epidemiology and pathogenesis of primary sclerosing cholangitis." UpToDate.  Accessed: October 2014.