PSC and Crohn’s both affect the GI tract. “Pathogenic mechanisms [causes] connecting the two have yet to be confirmed, but there are several proposed,” says Pratima Dibba, MD, a gastroenterologist in private practice in New York City.
“[These include] an autoimmune mechanism, bacterial translocation, ischemia (low oxygen) to bile ducts, genetic associations, and genetic mutations specifically affecting bile transport,” says Dr. Dibba. An imbalance in the gut microbiome may also play a role in this link.
PSC happens less often in Crohn’s disease than ulcerative colitis, another form of IBD, says Muyiwa Awoniyi, MD, PhD, a transplant hepatologist at Cleveland Clinic in Ohio. About 60 to 80 percent of people with PSC have IBD, but only 20 percent of those have Crohn’s. One review of 61 studies found that fewer than 1 percent of people with Crohn’s had PSC, and it was slightly more common in women.
Crohn’s disease increases your risk for colorectal cancer, and if you also have PSC, your risk goes up even more, says Dibba. As a result, you will need more frequent colonoscopies. Frequent cell turnover (development of new cells) in the GI tract caused by intestinal damage from Crohn’s increases the chance of mutations that can turn cancerous. The inflammation caused by PSC can boost this risk even more. Beyond colon cancer, it can also pave the way for bile duct cancer and gallbladder cancer.
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