Introduction The association between primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) is well recognised. The prevalence of PSC in patients with UC has been reported widely and ranges from 2.4% to 7.5%. The mean annual incidence rates were between 0.9 and 1.3 cases per 100 000 person years. Patients with UC may frequently be found to have abnormal liver biochemistry (LFTs) for numerous reasons although PSC is uncommon. Given the known increased risk of colorectal cancer in patients with both UC and PSC as well as cholangiocarcinoma, early recognition of PSC is crucial.
Methods Aims: To identify known patients with UC from our clinic population who also had persistently elevated LFTs and to determine the extent to which the cause of the abnormal LFTs had been investigated.
Methods A representative sample of patients with UC was identified from those who had contacted the nurse led IBD telephone help line at Gloucestershire Hospitals NHS Foundation Trust during September and October 2010. UC diagnosis was based on histology proven on biopsies including colectomy. Abnormal LFTs were defined as a persistent elevation above the local laboratory upper limit of normal (ALT >40 IU/l, ALP >200 IU/l, GGT >30 IU/l and bilirubin >17 mmol/l). The investigations performed to identify the cause of the abnormalities were noted.
Results A total of 450 phone calls were made to the IBD help line during the study period. Of those, 82 patients with ulcerative colitis were identified. Of these, 15 patients (18.3%) had so far been found to have abnormal LFTs at some time during the course of their illness. Persistently abnormal LFTs were identified in 10 patients (12.2%). Of these 10, 6 (60%) had auto immune screen, four patients (40%) had viral hepatitis screen, four patients (40%) had a liver ultrasound, three patients (30%) had CT abdomen. Furthermore no patients had targeted investigations to exclude PSC such as a liver biopsy or magnetic resonance cholangiography.
Conclusion Our results suggest that 12% of ulcerative colitis patients in our cohort had persistently abnormal liver function tests although none had had further investigations for PSC. Given expected prevalence data we could perhaps expect to see one patient with PSC in this cohort. The monitoring and following of LFTs in patients with UC should be part of standard follow-up procedures.
Competing interests None declared.
References 1. Chapman R, Fevery J, Kalloo A, et al. Diagnosis and management of primary sclerosing cholangitis. Hepatology 2010;51:600–78.
2. Tishendorf JJW, Geier A, Trautwein C. Current diagnosis and management of primary sclerosing cholangitis. Liver Transplantation 2008;14:735–46.
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