Hepatobiliary disease that precedes ulcerative colitis

There is a variable temporal relationship between the presenting symptoms of inflammatory bowel disease and associated hepatic disease: hepatobiliary disease may precede, occur with, or occur many years after the onset of the bowel disease. We describe six patients in whom hepatobiliary disease of initially obscure origin preceded the development of inflammatory bowel disease. The colitis which subsequently developed in these patients was symptomatically mild. In our series, there was a high prevalence of sclerosing cholangitis. We conclude that in patients with chronic hepatobiliary disease of obscure origin, evaluation should include detailed questioning about bowel symptoms and routine sigmoidoscopy to screen for subclinical colitis. If a diagnosis of colitis is made in such a patient, endoscopic retrograde cholangiography may be indicated to evaluate the biliary tree for sclerosing cholangitis.