Nongenetic Risk Factors for Primary Sclerosing Cholangitis

Summary and Comment |
July 1, 2014

Nongenetic Risk Factors for Primary Sclerosing Cholangitis

  1. Atif Zaman, MD, MPH

A newly observed association with reproductive hormonal activity in women should be explored further.

  1. Atif Zaman, MD, MPH

The specific causes of primary sclerosing cholangitis (PSC) are unknown, as are its associated comorbidities and an effective treatment. The disease likely has a genetic component, and its association with inflammatory bowel disease strongly suggests an immune-mediated component. However, little is known about possible nongenetic lifestyle and environmental factors that influence the development of PSC.

In 2011, all living patients in the Norwegian PSC registry were invited to participate in a questionnaire study. Questionnaire items included dietary habits, comorbidities, lifestyle factors, and workplace exposures. Gender and age–matched control patients were identified from the Bone Marrow Donor Registry.

Of 336 participants invited, 245 completed the questionnaire (response rate, 73%). Data from 240 patients were analyzed. Results included:

  • Compared with controls, patients with PSC had lower body-mass index, were less likely to have a college education, and had a higher prevalence of inflammatory bowel disease.

  • Lifestyle risk factors associated with PSC included a lower rate of coffee drinking (76% vs. 86% in controls; P=0.006), lower daily coffee consumption (mean cups daily, 2.7 vs 4.0; P<0.001), and a lower rate of smoking (current daily smoking, 2% vs. 15%; P<0.001 and ever daily smoking, 20% vs. 43%; P<0.001).

  • Among women, fewer patients with PSC reported ever using hormonal contraception compared with controls (51% vs. 85%, P<0.001). In addition, a strong linear correlation existed between parity before the onset of PSC and age at diagnosis (r=0.63, P<0.001).


This analysis confirms a previous finding of a negative association between smoking and PSC. A negative association is also noted here with coffee consumption, suggesting a protective effect. This result is in line with prior findings suggesting an overall hepatoprotective effect of coffee (NEJM JW Gastroenterol Mar 16 2012, NEJM JW Gastroenterol Jan 8 2010, and NEJM JW Gastroenterol Aug 3 2007). The intriguing findings among women suggest that hormonal factors may influence the risk for and onset of PSC and merit further exploration.

Editor Disclosures at Time of Publication

  • Disclosures for Atif Zaman, MD, MPH at time of publication Nothing to disclose


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