LIVER INVOLVEMENT AND ITS COURSE IN PATIENTS OPERATED ON FOR ULCERATIVE-COLITIS

The prevalence of associated liver involvement in 214 patients with ul cerative colitis undergoing definitive surgery was evaluated, with spe cial emphasis on the subsequent course of Liver changes. At the time o f colectomy or protocolectomy 45 patients (21%) had more than transien t liver involvement, and 13 (6,1%) fulfilled the criteria of primary s clerosing cholangitis (PSC). Of the other 32 patients with minor liver involvement four had steatosis, one chronic active hepatitis, one vir al A hepatitis, and 14 possibly early sclerosing cholangitis or unspec ific reactive hepatitis. During a mean follow-up of nine years, four p atients with PSC (31%) showed clinical progression, but none of those with minor histological changes or those with no liver disease at surg ery 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 associat ion with ulcerative colitis is not always a progressive disease, and p rotocolectomy may have a beneficial effect on the long-term course of sclerosing cholangitis in its early phase.