Liver involvement and its course in patients operated on for ulcerative colitis

The prevalence of associated liver involvement in 214 patients with ulcerative colitis undergoing definitive surgery was evaluated, with special emphasis on the subsequent course of liver changes. At the time of colectomy or proctocolectomy 45 patients (21%) had more than transient liver involvement, and 13 (6.1%) fulfilled the criteria of primary sclerosing cholangitis (PSC). Of the other 32 patients with minor liver involvement four had steatosis, one chronic active hepatitis, one viral A hepatitis, and 14 possibly early sclerosing cholangitis or unspecific reactive hepatitis. During a mean follow-up of nine years, four patients with PSC (31%) showed clinical progression, but none of those with minor histological changes or those with no liver disease at surgery did so. Alkaline phosphatase levels showed a decreasing tendency, and minor histological changes improved after surgery, while repeated cholangiography mostly demonstrated progression or a static state. The results indicate that asymptomatic sclerosing cholangitis in association with ulcerative colitis is not always a progressive disease, and proctocolectomy may have a beneficial effect on the long-term course of sclerosing cholangitis in its early phase.