CHRONIC INFLAMMATORY CHANGES IN THE POUCH MUCOSA ARE ASSOCIATED WITH CHOLANGITIS FOUND ON PEROPERATIVE LIVER-BIOPSY SPECIMENS AT RESTORATIVE PROCTOCOLECTOMY FOR ULCERATIVE-COLITIS

Background: The clinical syndrome of primary sclerosing cholangitis (P SC), diagnosed in about 5% of patients with ulcerative colitis (UC), h as been shown to be associated with pouchitis after ileal pouch-anal a nastomosis. The aim of this study was to ascertain whether UC patients with cholangitis on liver biopsy at proctocolectomy, with or without the clinical syndrome of PSC, have an increased risk of inflammatory c hanges in the ileal reservoir mucosa and clinical pouchitis. Methods: Of the consecutive 81 UC patients treated with restorative proctocolec tomy with ileal J reservoir at Tampere University Hospital between 198 5 and 1991, 73 with peroperative liver biopsy were included. A peroper ative liver biopsy was obtained during proctocolectomy. After a median follow up of 64 months, pouch biopsy specimens were obtained. Periods of clinical pouchitis were diagnosed by means of clinical criteria al one or by clinical criteria combined with the results of previous pouc h endoscopies in all patients. Results: Ten patients (14%) showed hist ologic features consistent with small-duct PSC on liver biopsy. Endosc opic retrograde cholangiography had previously been performed on four of these patients, and all four had large-duct PSC. Patients with chol angitis had significantly more severe chronic, but not acute, inflamma tion in the pouch mucosa than patients without cholangitis. At least o ne episode of pouchitis occurred in 30% of the patients without cholan gitis as compared with 90% of the patients with cholangitis. Chronic p ouchitis was more frequent in the group with cholangitis than in the g roup without it (70% versus 11%). Conclusions: The only means of detec ting all UC patients with cholangitis is a liver biopsy. Cholangitis, either with the clinical syndrome of PSC or found on liver biopsy, see ms to be a risk factor for chronic-type inflammatory changes in the po uch mucosa and for the development of pouchitis.