LIVER-DISEASE IN ULCERATIVE-COLITIS - AN EPIDEMIOLOGIC AND FOLLOW-UP-STUDY IN THE COUNTY OF STOCKHOLM

In an epidemiological study of the incidence of ulcerative colitis (UC ) in the county of Stockholm between 1955 and 1979, 1274 patients with UC were discovered. Almost all these patients had regularly been inve stigated with liver function tests; 142 (11%) of them showed signs of hepatobiliary disease. A follow up study on all 142 patients with abno rmal liver function and UC was made between 1989 and 1991 to evaluate the cause of the liver abnormality and to find out if the liver diseas e had affected the survival rates. At follow up, eight patients were r eclassified as having Crohn's disease, 60 had developed normal liver f unction as judged from test results, while the remaining 74 still had signs of hepatobiliary disease. The most common explanation for a tran sient abnormality in liver function was active colitis. The temporary signs of liver injury were not associated with changes in survival rat es for these patients. Infections, especially those because of hepatit is B and C virus transmitted by blood transfusions accounted for the a bnormalities in liver function in 21 patients, nine of which had a chr onic, but non-fatal course. Twenty nine (2.3%) of the patients develop ed primary sclerosing cholangitis (PSC), and 12 of them died during th e study period four because of cholangiocarcinoma and eight because of hepatic failure; one patient had a transplant. The estimated median t ime of survival from the first presentation of evidence of a liver fun ction, compatible with the diagnosis of PSC, to death or liver transpl antation was 21 years. A comparison of survival rates in patients with UC and patients with UC and concurrent PSC showed, a significant redu ction in survival in the PSC group (p<0.0001). The number of patients with UC who developed PSC remained constant during the study period. T hus, although evidence of abnormal liver function is a common finding in UC, a spontaneous return to normal levels is common. In this study, which did not have a selection bias, the median time of survival amon g PSC patients was far longer than previously described although devel opment of PSC among patients with UC does significantly reduce the est imated median of survival.