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

Objective. In this follow-up study, we examined colectomized ulcerativ e colitis patients with even minor histological liver abnormalities, w ho underwent perioperative liver biopsy between 1982 and 1987, to asse ss 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 patie nts 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 an d before the follow-up biopsy. The mean follow-up period was 46 months . Results: in five out of seven patients whose initial liver biopsy sh owed primary sclerosing cholangitis (PSC) like cholangitis, the stage of the disease remained unchanged or had progressed. There were no sta tistically significant improvements in liver function test values. All but one of the eight patients with non-specific reactive hepatitis (N RH) on initial biopsy showed normal liver histology on follow-up. Seve n of the nine patients with steatosis initially had normal liver histo logy on follow-up. Two of the eight patients with a normal initial liv er biopsy had abnormalities on follow-up, one moderate steatosis and t he other lymphoid cholangitis. Conclusions: There now appears to be co nvincing evidence that proctocolectomy has no beneficial effects on PS C-like cholangitis in patients with ulcerative colitis. However, NRH a nd steatosis appear to disappear or be subdued after colectomy. The di sappearance of NRH in most patients after proctocolectomy suggests tha t this procedure may protect the liver from further damage, possibly c aused by toxins related to colitis.