ABSTRACT
There has been conflicting evidence to both support and refute the rationale of liver biopsy as a gold standard for diagnosis of existing disease of the liver in patients with ulcerative colitis [UC]. A trial to Identify UC patients in whom liver biopsy could be justified for detection of hepatobiliary abnormalities. The study included 60 patients with established diagnosis of UC based on clinical, laboratory, radiological, colonoscopic and histopathological characteristics. Following medical history, clinical examination and laboratory investigations, assessment of the liver was done using abdominal ultrasound scan. Liver biopsy and histopathological examination was performed for patients having sonographic hepatic affection with raised transaminases. Group 1 included 26 patients with sonographic hepatobiliary abnormalities [group 1a; 11 patients with elevated transaminases and group 1b; 15 patients with normal transaminases]. Group 2 included 34 patients without sonographic hepatobiliary changes. 75% of the studied UC patients had moderate-to-severe disease activity. Group 1 patients had more severe UC disease activity than group 2 [P= 0.018]. Duration of ulcerative colitis disease was longer and abdominal tenderness and hepatomegaly were significantly more in group 1 than group 2 patients [P= P=0.0001, 0.006 and 0.000 respectively]. ALP, ALT and AST levels were significantly higher in group 1 than group 2 patients [P = 0.007, 0.004 and 0.0001 respectively]. Serum bilirubin, ALP, AST and ALT were significantly higher in group la than group 1b patients [P = 0.026, 0.021, 0.001, and 0.001, respectively]. The pathology results of liver biopsies in group la patients proved small duct "PSC" in one patient, nonspecific reactive hepatitis in 4 patients and liver steatosis in 6 patients. Minor abnormalities in liver tissue are common in UC patients particularly in presence of sonographic and biochemical evidence of liver disease and liver biopsy could be justified in this subset of patients