{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T16:47:48Z","timestamp":1785862068527,"version":"3.56.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2015,8,28]],"date-time":"2015-08-28T00:00:00Z","timestamp":1440720000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006483","name":"AbbVie","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006483","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2016,1]]},"abstract":"Abstract<\/jats:title>Background & Aims<\/jats:title>Primary sclerosing cholangitis (PSC<\/jats:styled-content>) is a progressive cholestatic liver disease of unknown cause, but strongly associated with inflammatory bowel disease (IBD<\/jats:styled-content>). Potential risk factors triggering PSC<\/jats:styled-content> have never been studied on a population level. The aim of this study was to evaluate smoking, appendectomy, family history and geographical distribution in a population\u2010based cohort of PSC<\/jats:styled-content> patients, as compared to IBD<\/jats:styled-content> control patients and healthy controls (HC<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>For this case\u2013control study 343 PSC<\/jats:styled-content> patients, 370 IBD<\/jats:styled-content> controls and 232 HC<\/jats:styled-content>'s living in a geographically defined area in the Netherlands filled\u2010out a questionnaire concerning smoking, appendectomy and family history of IBD<\/jats:styled-content> and autoimmune liver diseases.<\/jats:p><\/jats:sec>Results<\/jats:title>Smoking was associated with a lower risk of developing PSC<\/jats:styled-content> in PSC<\/jats:styled-content>\u2010ulcerative colitis (UC<\/jats:styled-content>) patients (adjusted OR<\/jats:styled-content> 0.21; 95% CI<\/jats:styled-content> 0.12\u20130.34; P<\/jats:italic>\u00a0<\u00a00.001). Comparable results were found for PSC<\/jats:styled-content>\u2010Crohn's disease (CD<\/jats:styled-content>) patients (16% former smokers) compared to CD<\/jats:styled-content> patients (55% former smokers) (adjusted OR<\/jats:styled-content> 0.17; 95% CI<\/jats:styled-content> 0.08\u20130.39; P<\/jats:italic>\u00a0<\u00a00.001). Frequency of appendectomy did not differ between PSC<\/jats:styled-content> and HC<\/jats:styled-content>, but PSC<\/jats:styled-content>\u2010UC<\/jats:styled-content> patients had undergone appendectomy more often than UC<\/jats:styled-content> patients (13% vs. 6%) (adjusted OR<\/jats:styled-content> 2.51; 95%CI<\/jats:styled-content> 1.04\u20136.07; P<\/jats:italic>\u00a0=\u00a00.041). We found no association between family history of IBD<\/jats:styled-content> or autoimmune liver disease and risk of PSC<\/jats:styled-content>. Degree of urbanization was not associated with PSC<\/jats:styled-content> incidence.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>In this large population\u2010based case\u2013control study we confirm that smoking is associated with a lower risk of developing PSC<\/jats:styled-content>, independent of its protective effect for developing UC<\/jats:styled-content>. Appendectomy is not associated with the risk of developing PSC<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12894","type":"journal-article","created":{"date-parts":[[2015,6,16]],"date-time":"2015-06-16T04:11:49Z","timestamp":1434427909000},"page":"84-91","source":"Crossref","is-referenced-by-count":29,"title":["Risk factors for primary sclerosing cholangitis"],"prefix":"10.1111","volume":"36","author":[{"given":"Kirsten","family":"Boonstra","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Academic Medical Center Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth M. 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C.","family":"Poen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Isala Clinics Zwolle the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carin M.","family":"van Nieuwkerk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology VU Medical Center Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben J.","family":"Witteman","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gelderse Vallei Hospital Ede the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans A.","family":"Tuynman","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Medical Center Alkmaar Alkmaar the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton 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