Prevalence and Bidirectional Association Between Primary Sclerosing Cholangitis and Crohn's disease: A Systematic Review and Meta-Analysis

Purpose: This meta-analysis aimed to evaluating the prevalence of Crohn's disease in primary sclerosing cholangitis (PSC) and the incidence of primary sclerosing cholangitis in Crohn's disease (CD), along with their interrelation.

Methods: An extensive search was conducted in the PubMed and Embase to identify available publications up to December 2023. Studies were included if they reported the prevalence of CD in PSC patients, or vice versa. Proportions were assessed using the DerSimonian and Laird method, followed by transformation via the Freeman-Tukey double inverse sine transformation. The quality of the included studies utilizing the Joanna Briggs Institute Critical Appraisal Checklist.

Results: Based on quantitative analysis of 61 studies, the prevalence of PSC in patients with CD was 0.88% (95% CI: 0.53%-1.30%). The prevalence of PSC in male CD patients was 0.45% (95% CI: 0.03%-1.16%). In female CD patients, the prevalence was 0.51% (95% CI: 0.09%-1.14%). The prevalence of CD with PSC was 11.27% (95% CI: 9.56%-13.10%). The prevalence of CD in male PSC patients was 10.71% (95% CI: 7.42%-14.50%). Among female PSC patients, the pooled prevalence of CD was 13.05% (95% CI: 11.05%-15.19%).

Conclusions: We found a significant bidirectional association between PSC and CD, with a higher prevalence of CD in female with PSC compared to male. These findings provide important epidemiological data for clinical practice.