BILE-DUCT BACTERIAL ISOLATES IN PRIMARY SCLEROSING CHOLANGITIS - A STUDY OF EXPLANTED LIVERS

Background/Aims: The pathogenesis of the inflammatory lesion in primar y sclerosing cholangitis is unknown, The clinical picture is character ized by i.a. episodes of fever, the cause of which also remains specul ative, Previous studies of bacterial isolates in the liver or bile duc ts in primary sclerosing cholangitis have had the shortcoming of possi ble contamination associated with the sampling, The aim of this study was to investigate whether bile and bile duct tissue, obtained under s terile conditions in connection with liver transplantation, contain ba cteria, Methods: We studied bile from bile duct walls and bile collect ed from the explanted livers of 36 patients with primary sclerosing ch olangitis and 14 patients with primary biliary cirrhosis. Results: Pos itive cultures were obtained from 21 of 36 primary sclerosing cholangi tis patients, but from none of the primary biliary cirrhosis patients, The number of bacterial strains was inversely related to the time aft er the last endoscopic retrograde cholangiography. Treatment with anti biotics or intraductal stent, or the occurrence of fever before liver transplantation did not seem to influence the culture results, whereas antibiotic treatment in connection with endoscopic retrograde cholang iography may possibly have reduced the number of isolates in the cultu res, Alpha-haemolytic Streptococci were retrieved as late as 4 years a fter the last endoscopic retrograde cholangiography, Retrospective ana lysis of liver laboratory tests after endoscopic retrograde cholangiog raphy did not indicate a deleterious effect of the investigation. Conc lusions: The data suggest that antibiotics should be given routinely i n connection with endoscopic retrograde cholangiography, They also rai se the question of a possible role of alpha-haemolytic Streptococci in the progression of primary sclerosing cholangitis.