Significance of microscopic cholangitis in alcoholic liver disease

Marked biochemical cholestasis mimicking extrahepatic obstruction may occur in alcoholic liver disease. Twenty-three consecutive hyperbilirubinemic alcoholics who underwent liver biopsy were studied. Comparison of the clinical, laboratory, and histological features was made between patients with no or rare intraductal polymorphonuclear leukocytes, group A (19 cases), and those with polymorphonuclear leukocytes in multiple bile ducts ("microscopic cholangitis"), group B (4 cases). Extrahepatic biliary obstruction was excluded in group B by cholangiography. Group B had significantly higher serum SGOT, bilirubin, alkaline phosphatase, and cholesterol than group A. All group B patients had periductal acute inflammation and severe panlobular cholestasis. However, there was no significant histological difference comparing group A patients with alkaline phosphatase greater than 300 mIU per ml and group B patients, except for the presence of intraductal polymorphonuclear inflammation. Therefore, we conclude that microscopic cholangitis is a feature of severe cholestasis which may accompany alcoholic liver injury.