Hepatic Lesions in Chronic Inflammatory Bowel Disease

Abstract

Summary Liver biopsies of 103 patients with inflammatory bowel disease were classified according to the diagnostic term which best described the hepatic changes. Pericholangitis was the main biopsy diagnosis in 33 patients, fatty change in 22, nonspecific reactive change in 22, and cirrhosis or bridging portal hepatofibrosis in 20. The most frequent form of cirrhosis was a relatively uniform, systematized alteration of hepatic architecture resembling the pattern usually noted in biliary cirrhosis. All stages between mild portal fibrosis and cirrhosis were seen in the biopsy material as a whole. Therapeutic agents used in treating inflammatory bowel disease could not be related to either the type or severity of liver lesions. Intensity or type of bowel disease, as defined by clinical criteria of severity or duration, did not correlate well with either the type or severity of the liver disease. Bacteriological cultures of material from 69 of the liver biopsies were essentially negative, suggesting that infection in the liver may not be a factor in the hepatic changes. Serum Bromsulphalein retention and alkaline phosphatase levels were the best laboratory measures of the presence of hepatic lesions. Since it was not possible to define any consistent relationship between chronic bowel disease and liver injury, and since liver function tests may be normal in the presence of hepatic injury, liver biopsy must be utilized to determine the type and severity of the liver disease. No specific recommendations concerning therapeutic measures can be made at this time; adequate treatment of the bowel disease appears to be the best available measure for the prevention and control of the hepatic complications.