P0244Bidirectional relationship between Primary Sclerosing Cholangitis (CSP) and Inflammatory Bowel Disease (IBD): a retrospective multicentic update of sicilian data

Abstract Background PSC-associated IBD (PSC-IBD) is a distinct phenotype characterized by gut–liver immune crosstalk. Data on disease interplay and progression are limited and conflicting. This study assessed the relationship between IBD and PSC features in a Sicilian cohort and their influence on hepatic and intestinal outcomes. Methods This retrospective multicenter observational study included 51 patients with PSC-IBD and 35 with isolated PSC followed across four Sicilian referral centers from January 2003 to August 2025. A control group of IBD patients without PSC was also analyzed. Demographic, clinical, and biochemical data were collected, including fecal calprotectin, C-reactive protein, IBD phenotype, flare frequency, and treatment history. Liver-related outcomes included cirrhosis progression, acute liver failure, transplantation, and mortality. Statistical analyses were performed using R software. Results PSC-IBD patients were younger at PSC diagnosis (48.5 vs. 59.9 years) and had lower BMI, liverstiffness, and cirrhosis prevalence compared with isolated PSC (7.8% vs. 40%). Despite more frequent extensive colitis, intestinal inflammation was generally mild, with fewer fistulizing Crohn’s cases and predominantly left-sided ulcerative colitis. Liver decompensation, portal hypertension, and cirrhosis occurred more frequently in isolated PSC, whereas PSC-IBD patients showed a slower hepatic progression. No clear association was observed between IBD activity and PSC progression. Conclusion PSC-IBD displays a distinctive clinicopathological profile, with earlier onset, milder liver disease, and indolent intestinal inflammation compared with isolated PSC or IBD. These findings support PSC-IBD as a unique entity and underscore the need for prospective studies to assess whether tight intestinal inflammation control can influence PSC outcomes. References: Kellermayer, R., Carbone, M., Horvath, T. D., Szigeti, R. G., Buness, C., Hirschfield, G. M., 80:155-168. Da Cunha T, et al. Primary Sclerosing Cholangitis and Inflammatory Bowel Disease: A Review. J Clin Transl Hepatol. 2022;10(3):531-542. Shah A, et al. Efficacy and safety of biologics in primary sclerosing cholangitis with inflammatory bowel disease: A systematic review and meta-analysis. Hepatology Communications. 2024;8:e0347. Bergquist A, Lindberg G, Saarinen S, Broomé U. Increased prevalence of primary sclerosing cholangitis among first-degree relatives. J Hepatol. 2005;42(2):252. Kim YS, et al. Primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD): a condition exemplifying the crosstalk of the gut–liver axis. Exp Mol Med. 2023;55:1380-1387. Zhang Y, et al. Prevalence of inflammatory bowel disease in patients with primary sclerosing cholangitis: A systematic review and meta-analysis. Liver Int. 2022;42:1814-1822. Bedke T, et al. Protective function of sclerosing cholangitis on IBD. Gut. 2024;73:1292-1301. Conflict of interest: Dr. Amato, Livia Maria: No conflict of interest Pennisi, Grazia: No conflict of interest Antoci, Chiara: No conflict of interest Di Maria, Gabriele: No conflict of interest Sferruzza, Arianna: No conflict of interest Caserta, Antonino: No conflict of interest Bronte, Fabrizio: No conflict of interest Viola, Anna: No conflict of interest Macaluso, Fabio Salvatore: Advisory board and/or lecture fees for: AbbVie, MSD Galapagos, Sandoz, Takeda, Janssen, Eli-Lilly, Pfizer, Alfasigma, Giuliani Scrivo, Barbara: No conflict of interest Li Voti, Raffaele: No conflict of interest Giacchetto, Marco: No conflict of interest Calvaruso, Vincenza: No conflict of interest Cammà, Calogero: No conflict of interest Cappello, Maria: None