Liver involvement in patients operated for ulcerative colitis, with special reference to the association of cholangitis with colorectal dysplasia andcarcinoma

This study classified liver changes found in patients undergoing proctocole ctomy for ulcerative colitis and examined whether patients with cholangitis have an increased risk of colorectal dysplasia and carcinoma. The patients were 152 who underwent liver biopsy during surgery for ulcerative colitis. Prior surveillance colonoscopy specimens and operative liver and proctocol ectomy specimens were examined histologically. Patients with dysplasia or c arcinoma in colorectal specimens were pair-matched to patients without such neoplasia. Sixteen (10.5%) patients had histological features consistent w ith small-duct primary sclerosing cholangitis on liver biopsy, five of them showing normal liver function values. Of the 152 patients 4 were found to have colon carcinoma (2.6%) and another 4 low-grade dysplasia (2.6%) either upon colonoscopy or in colectomy specimens. The median duration of the col itis in the 8 patients with colorectal neoplasia was 12 years (range 2-29) and in the other 142 patients 4 years (0.1-33; P=0.007). The prevalence of primary sclerosing cholangitis (PSC) or cholangitis was 50% in cases with c olorectal neoplasia and 13% in pair-matched controls without colorectal neo plasia. In this selected group of patients operated on for ulcerative colit is the prevalence of histological cholangitis was thus higher than that of PSC in previous epidemiological studies. In addition, the prevalence of PSC or cholangitis was much higher in cases with colorectal neoplasia than in pair-matched controls without colorectal neoplasia. Our results support the view that cholangitis constitutes an additional risk factor underlying col orectal dysplasia or carcinoma.