What is the evidence that ursodeoxycholic acid lowers CRC risk in patients with UC and PSC
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the data are conflicting and dose-dependent: standard-dose ursodeoxycholic acid has been associated with reduced colonic dysplasia/neoplasia in ulcerative colitis with primary sclerosing cholangitis, but high-dose therapy has been associated with an increased risk of colorectal neoplasia 1–3. the favorable signals come mainly from small observational and cross-sectional studies rather than definitive trials 1,4.
## References
1. Bernstein CN, Eaden J, Steinhart AH, Munkholm P, Gordon PH. Cancer prevention in inflammatory bowel disease and the chemoprophylactic potential of 5-aminosalicylic acid. Inflamm Bowel Dis. 2002;8:356-61. PMID: 12479651.
2. Collins PD, Mpofu C, Watson AJ, Rhodes JM. Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease. Cochrane Database Syst Rev. 2006(2):CD000279. PMID: 16625534.
3. Sebastian S, Hernández V, Myrelid P, Kariv R, Tsianos E, Toruner M, Marti-Gallostra M, Spinelli A, van der Meulen-de Jong AE, Yuksel ES, Gasche C, Ardizzone S, Danese S. Colorectal cancer in inflammatory bowel disease: results of the 3rd ECCO pathogenesis scientific workshop (I). J Crohns Colitis. 2014;8(1):5-18. PMID: 23664897.
4. Croog VJ, Ullman TA, Itzkowitz SH. Chemoprevention of colorectal cancer in ulcerative colitis. Int J Colorectal Dis. 2003. PMID: 12904996.
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⚠ Required context not in this corpus (severe). The high-dose UDCA (28-30 mg/kg/d) trial in PSC was TERMINATED at 6 years for futility, and reported HARM: a 2.3x higher risk of the primary endpoint, 2.1x higher death/transplantation/minimal listing criteria (P = 0.04), and serious adverse events in 63% vs 37% (Lindor 2009, PMID 19585548; Imam 2011, PMID 21957881).
_Why this matters:_ An answer that calls high-dose UDCA merely 'unproven', or leaves open that a higher dose might help, can push a clinician toward a dose an RCT stopped for harm.
_Added by the landmark interlock. This corpus is surgical in scope and cannot admit the source paper (PMID 19585548, 21957881). Not generated by the RAG._
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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._
Reviewer notes