The Significance of Enzymatic Cholestasis in Inflammatory Bowel Disease Patients for the Diagnosis of Primary Sclerosing Cholangitis—A Retrospective Study

This retrospective longitudinal study evaluated the significance of cholestasis syndrome and the diagnosis of primary sclerosing cholangitis (PSC) in inflammatory bowel disease (IBD) patients from a tertiary center in Romania. Methods: From 2011 to 2022, 3767 patients suspected for IBD were evaluated, with 2499 confirmed cases. Of these, 34 patients (1.36%) had an IBD-PSC phenotype. Of the IBD-PSC cases, 56% were associated with UC and 44% with CD. Results: Enzymatic cholestasis was observed in 13.3% of IBD patients, with gamma-glutamyl transpeptidase (GGT) elevated in 70.2% and alkaline phosphatase (ALP) in 51.3%. However, only 10.2% of the patients with enzymatic cholestasis were diagnosed with PSC. Other liver diseases identified included metabolic-associated steatotic liver disease (MASLD), chronic viral hepatitis, Primary Biliary Cholangitis, autoimmune hepatitis, and liver neoplasms. A higher incidence of cholangiocarcinoma (11.76% vs. 0.24%, p < 0.001) and liver-related death (8.82% vs. 0.65%, p < 0.001) was found between IBD-PSC patients and those without PSC. PSC-CD patients were diagnosed at a younger age (30.2 vs. 43 years, p < 0.001), had higher rates of severe disease (73.3% vs. 10.5%, p < 0.001), required more biological treatment (60% vs. 15.7%, p < 0.001), and experienced higher mortality (20% vs. 0%, p < 0.001). Discussions: This study represents the most extensive cohort analysis of PSC-IBD patients in Romania and Eastern Europe, highlighting clinical differences between PSC-UC and PSC-CD phenotypes. Conclusions: The regular monitoring of ALP and GGT in IBD patients helps detect liver diseases, including PSC. However, only one in ten patients with IBD and enzymatic cholestasis was diagnosed with PSC.