THE EFFECT OF COLECTOMY ON HISTOLOGICAL AND BIOCHEMICAL LIVER CHANGES ASSOCIATED WITH ULCERATIVE-COLITIS

Objective. In this follow-up study, we examined colectomized ulcerative colitis patients with even minor histological liver abnormalities, who underwent perioperative liver biopsy between 1982 and 1987, to assess the effect of colectomy on histological and biochemical features of the liver. Methods: We performed a follow-up liver biopsy on 24 (71%) of the 34 patients with liver abnormalities together with eight patients with initially normal liver biopsy specimens. Liver function tests, such as alkaline phosphatase, alanine aminotransferase and bilirubin levels, were analysed before the initial liver biopsy on colectomy and before the follow-up biopsy. The mean follow-up period was 46 months. Results: in five out of seven patients whose initial liver biopsy showed primary sclerosing cholangitis (PSC) like cholangitis, the stage of the disease remained unchanged or had progressed. There were no statistically significant improvements in liver function test values. All but one of the eight patients with non-specific reactive hepatitis (NRH) on initial biopsy showed normal liver histology on follow-up. Seven of the nine patients with steatosis initially had normal liver histology on follow-up. Two of the eight patients with a normal initial liver biopsy had abnormalities on follow-up, one moderate steatosis and the other lymphoid cholangitis. Conclusions: There now appears to be convincing evidence that proctocolectomy has no beneficial effects on PSC-like cholangitis in patients with ulcerative colitis. However, NRH and steatosis appear to disappear or be subdued after colectomy. The disappearance of NRH in most patients after proctocolectomy suggests that this procedure may protect the liver from further damage, possibly caused by toxins related to colitis.