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.