Health-Related Quality of Life after Restorative Proctocolectomy: A Cross-Sectional Study.

BACKGROUND AND AIMS:: Patients undergoing restorative proctocolectomy have often suffered from active ulcerative colitis which should be remembered when assessing quality of life after operation. The aim of this study was to explore health-related quality of life after restorative proctocolectomy in those with poor or good pouch function and to compare that to patients with active or inactive ulcerative colitis and to the general population. MATERIAL AND METHODS:: Altogether, 282 restorative proctocolectomy patients were investigated. The control group comprised 408 ulcerative colitis patients from the local register. Generic 15D and disease-specific inflammatory bowel disease questionnaire health-related quality of life instruments were used. Population-based data were available for 15D. Pouch function was evaluated with Öresland score and colitis activity with simple clinical colitis activity index. RESULTS:: 15D results showed that patients with good pouch function had health-related quality of life similar to that of the general population. Health-related quality of life with inflammatory bowel disease questionnaire was equally good in patients with good pouch function (n = 131; 70%) and inactive colitis (n = 95; 63%), and equally impaired in patients with poor pouch function (n = 56; 30%) and active colitis (n = 18; 12%). CONCLUSION:: The majority of patients had health-related quality of life comparable to that in general population. Most patients with active ulcerative colitis are likely to improve their health-related quality of life after successful surgery. These findings are important when informing colitis patients about life after surgery.

Antegrade transverse or sigmoid colonic enema through a percutaneous endoscopic gastrostomy tube is an option in the treatment of colorectal dysfunction.

BACKGROUND: Antegrade colonic enemas are used in patients with colorectal dysfunction resistant to conservative therapy. A number of different operative techniques are applied, but their effectiveness is by and large unknown. We therefore evaluated the long-term usefulness of the left-sided percutaneous endoscopic gastrostomy (PEG) tube method in adult patients. METHODS: Twenty-one patients with colorectal dysfunction underwent insertion of a PEG tube colostomy by laparotomy between 1997 and 2006. In 2014, we evaluated how many of the patients had the tube still in place, how the patients coped with the tube, and what the reasons for the removal were. RESULTS: The main indications were severe constipation or fecal incontinence mainly related to neurological diseases. In 2014, 5 out of 21 patients had the tube still in use (median follow-up 14 years, range 11-17 years) and 4 out of 5 deceased patients had had the tube in use until their death, unrelated to this treatment (median follow-up 7 years, range 0-8 years). Four out of the 5 living patients considered the benefit of the tube to be good or excellent. Tubes were removed in 11 (52%) patients for various reasons, local skin irritation being the most common. CONCLUSIONS: A left-sided PEG tube colostomy was removed in over half of the patients, but despite that, it still seems to be a viable long-term option in the treatment of individual patients with colorectal dysfunction, when conservative methods are ineffective.

Restorative Proctocolectomy for Ulcerative Colitis in 1985-2009.

BACKGROUND AND AIMS: Restorative proctocolectomy is the most common operation in patients with ulcerative colitis. The aim was to evaluate long-term changes in our operative treatment and early and late complications related to restorative proctocolectomy. MATERIAL AND METHODS: The study comprised 352 (149 females) patients over 18 years of age with ulcerative colitis who underwent restorative proctocolectomy in 1985-2009 median follow-up time of 5 years. RESULTS: The indication for surgery was active chronic colitis in 168 (47.7%), acute colitis in 159 (45.2%), and cancer or dysplasia in 25 (7.1%) patients. Ileal pouch-anal anastomosis was performed using hand-sewn anastomosis with mucosectomy in 283 patients and stapled anastomosis in 69. A shift from hand-sewn to stapler ileal pouch-anal anastomosis took place in 2005. Covering ileostomy was carried out in 133 (37.8%) patients. There were 82 (23.3%) J-pouch-related complications. The operative mortality was 0.3%. There were significantly fewer leakages and early re-operations when covering ileostomy was used than when it was omitted: 6.0% versus 16.4% (p = 0.004), 4.5% versus 11.9% (p = 0.02), respectively. There were more strictures in hand-sewn than in stapled ileal pouch-anal anastomoses (17.6% vs. 0%, p = 0.001). Pouchitis occurred at least once in 134 (38.1%) patients. CONCLUSION: The ileal pouch-anal anastomosis technique used in restorative proctocolectomy had changed over the past years from hand-sewn to stapled anastomosis. Covering ileostomy seemed to protect against major complications. Pouchitis was the most common late complication.

Prevalence of faecal incontinence in adults aged 30 years or more in general population.

OBJECTIVE: The aim of this study was to estimate the prevalence of and factors associated with faecal incontinence in a Finnish population. METHOD: A population-based age-stratified random sample of 8000 people aged 30-81 years from a large city was obtained from the national population registry. A postal questionnaire was sent to all subjects. Questions regarding faecal incontinence were adopted from a previously developed validated questionnaire. RESULTS: Response rate was 39.8%. Overall, the prevalence of faecal incontinence occurring in any frequency within the last year was 10.6% (CI: 9.5-11.6%). Women suffered significantly more often than men (11.9% vs. 8.7%). The prevalence of faecal incontinence occurring at least twice a month was 5.2% (CI: 4.5-6%). Of these subjects, 62.3% used a pad at least twice a month to protect their underwear (91 women, 10 men), 23.6% used it daily. There was a strong correlation between faecal incontinence and urinary incontinence. Of the 162 subjects reporting faecal incontinence at least twice a month, only 27.2% had discussed the problem with their physician. In 12.4%, their physician had raised the question of faecal incontinence. Only 10% had received treatment for it, but 66% (107/162) felt they needed treatment. CONCLUSION: Faecal incontinence is a common problem. Only a minority had reported this symptom to their physician and surprisingly few had received treatment for it. General awareness of faecal incontinence and treatment options should be improved among primary care physicians and general population.

Histological and macroscopic changes in the pelvic pouch: long-term follow up after restorative proctocolectomy for ulcerative colitis (UC).

OBJECTIVE: Our aim was to evaluate macroscopic and histological (inflammatory) changes in ileal pouch mucosa after restorative proctocolectomy with J-pouch-ileoanal anastomosis for UC during long-term follow up. PATIENTS AND METHODS: Thirty-six (56%) out of 64 consecutive patients operated at our Institute during 1985-90 underwent endoscopy of the reservoir in the years 1994 and 1998. Functional outcome and macroscopic changes were recorded and histological samples taken from the three levels of the pelvic pouch. Acute and chronic inflammation were graded in accordance with a well-established histopathologic scoring system. RESULTS: The functional outcome was unchanged in 26 (72%), became worse in eight (22%) and better in two (6%) cases during follow up. The number of macroscopic changes increased during follow up and there was a tendency for them to become more common in the distal pouch. Microscopic acute and chronic inflammation decreased during follow up. There were more severe inflammatory changes in the distal pouch. Both acute and chronic inflammatory scores were higher through the reservoir in the cases of chronic pouchitis. Chronic pouchitis occurred more often in males. CONCLUSION: Macroscopic and inflammatory changes in the pelvic pouch seem to have separate progress during long-term follow up. In chronic pouchitis both acute and chronic inflammation are pronounced and spread over the entire pelvic pouch mucosa.

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

This study classified liver changes found in patients undergoing proctocolectomy 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 proctocolectomy specimens were examined histologically. Patients with dysplasia or carcinoma in colorectal specimens were pair-matched to patients without such neoplasia. Sixteen (10.5%) patients had histological features consistent with 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 colitis 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 colorectal neoplasia and 13% in pair-matched controls without colorectal neoplasia. In this selected group of patients operated on for ulcerative colitis 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 colorectal dysplasia or carcinoma.

Ileal pouch-anal anastomosis operation in children versus adults.

BACKGROUND AND AIMS: To evaluate early results of elective ileal pouch-anal operations in children under the age of fifteen as compared to adult patients operated during the same period by the same surgical team. MATERIAL AND METHODS: Eighty-two patients with ulcerative colitis underwent restorative proctocolectomy during a six-year period, 1991-1996. Twelve of them (16%) were under the age of 15 years. Peroperative and short term postoperative morbidity were compared between the two groups. RESULTS: Covering loop ileostomy was performed on one patient in the juvenile group and 5 (7%) in the adult group. There were no significant differences in postoperative complications between the two groups. Eight (11%) leakages occurred in the adult group as compared to none in the juveniles. The children had a higher incidence of unexplained postoperative fever (50% versus 21%). Seven adults (10%) but no children underwent re-operation for these early complications. CONCLUSIONS: It would appear that a team of experienced gastroenterologic surgeons can operate children as well as adults for ulcerative colitis with comparable early results without additional morbidity.

Functional results of anterior levatorplasty and external sphincter plication for faecal incontinence.

BACKGROUND AND AIMS: The aim of this study was to assess results of anterior levatorplasty combined with external anal sphincter plication for faecal incontinence. MATERIAL AND METHODS: The study involved 44 female patients, 27 with idiopathic and 17 with traumatic faecal incontinence. All underwent anterior levatorplasty and external sphincter plication in our institution between 1986 and 1997. The patients were followed up clinically for a mean 12 (range 2-54) months and 39 (89%) patients also underwent pre-and postoperative anal manometry. RESULTS: In the idiopathic group 5 patients (19%) estimated that the result of the operation had been good and another 18 (67%) reported feeling better than before; the corresponding figures in the traumatic group were 4 (24%) and 10 (59%). The Wexner incontinence score decreased significantly after the operation in both groups. Nineteen patients (70%) in the idiopathic and 14 (82%) in the traumatic group showed improvement of one or more scores on the Kirwan scale. Three patients regained continence completely, one in the traumatic and two in the idiopathic group. There were no significant improvements in mean resting anal pressure or functional anal canal length in either group. Mean squeeze pressure improved significantly only in the traumatic group. CONCLUSIONS: Although the results of anterior levatorplasty combined with external sphincter plication are not perfect, the approach seems to be a valuable alternative in the treatment of patients with idiopathic or traumatic faecal incontinence. Complete continence is seldom achieved, but the grade of incontinence is reduced in the majority of patients.

Fibrin glue in perianal fistulas--a pilot study.

BACKGROUND AND AIMS: Anal fistula surgery is associated with considerable morbidity, mainly related to anal incontinence. As promising results of the use of fibrin glue in the treatment of complex anal fistulas were recently shown, we planned to do a randomized trial comparing the use of fibrin glue and surgery in the treatment of perianal fistulas. There were no reports of the use of fibrin glue in the management of previously untreated anal fistulas. MATERIAL AND METHODS: Prior to the planned study a pretrial pilot series of 10 patients with different perianal fistulas were treated. Informed consent was obtained from every patient. Under spinal anesthesia, the fistula track was identified and brushed to remove granulous tissue, then washed with hydrogen peroxide and thereafter filled with fibrin glue. RESULTS: We performed fibrin gluing on 10 patients with perianal fistulas of different etiology and type. The gluing was done once to 7 patients, twice to 2 and three times to one patient. In all but one patient the fistula and symptoms recurred after only one month. One patient with a low trans-sphincteric fistula of which the internal opening was not found, was symptom-free for 6 months. At the one-month follow-up visit the external opening of the fistula was almost unidentifiable, suggesting that the fistula had healed. However, due to recurrence fistulotomy was performed after 6 months. CONCLUSIONS: Fistulas around the anus, with or without associated inflammatory bowel disease, do not seem to heal after fibrin gluing.

Functional results of operative treatment of rectal prolapse over an 11-year period: emphasis on transabdominal approach.

PURPOSE: A variety of surgical procedures have been developed to treat rectal prolapse, but there is still no consensus on the operation of choice. The aim of this study was to evaluate the functional results of operative treatment of rectal prolapse during an 11-year period in our department. METHODS: All patients treated for complete rectal prolapse during an 11-year period, from 1985 to 1995, in a single university hospital were included. Of the 123 patients, 22 were men, and the mean age was 59 (range, 15-88) years. The medical records of all patients were reviewed retrospectively, and a questionnaire on bowel symptoms before and after surgery was sent to all 95 living patients. RESULTS: The majority of the procedures (91 percent) were performed by abdominal approach, and the most frequently used open technique was posterior rectopexy with mesh (78 percent). Of the incontinent patients, 35 (63 percent), all those less than 40 years of age and 64 percent of those 40 years or older, were continent postoperatively (P = 0.0001) after a median follow-up of five (range, 1-72) months. According to the questionnaire, after a median follow-up of 85 (range, 16-144) months, only 38 percent of the incontinent patients in the mesh or suture group, 78 percent of patients less than 40 years of age (n = 18), and 52 percent of those 40 years or older (n = 47) claimed to be continent postoperatively. The proportion of patients with constipation was greater after the operation than preoperatively (P = 0.02) and more patients used medication for constipation after than before the operation (P = 0.0001). The overall complication rate was 15 percent, and the mortality rate was 1 percent (1/123). In the mesh or suture group there were 6 (6 percent) recurrent complete prolapses and 11 (12 percent) mucous prolapses. CONCLUSION: Posterior rectopexy with mesh gave good results in our hands. Older age and longer follow-up seem to have a negative effect on the functional outcome of the operation and on the recurrence rate.

Small-bowel angiosarcoma after pelvic irradiation: a report of two cases.

Angiosarcoma is a rare tumor in the small bowel. Several predisposing factors have been suggested, including external irradiation for another malignancy. Only six cases of small-bowel angiosarcoma in patients previously treated with pelvic irradiation for gynecological malignancies have been reported hitherto. We present here two patients in whom a diagnosis of small-bowel angiosarcoma was made 10 years or more after intrapelvic irradiation. These cases demonstrate poor prognosis in this disease. Although postirradiation angiosarcoma is a rare condition, its possibility should be kept in mind when operating on previously irradiated patients.

Laparoscopic versus open preperitoneal inguinal hernia repair: a prospective randomised trial.

BACKGROUND AND AIMS: Before choosing between open and laparoscopic preperitoneal tension-free repair, a study comparing their safety and short-term outcome was needed. No randomised studies comparing the two hernia repair techniques have hitherto been published. MATERIAL AND METHODS: A prospective randomised study was carried out comparing laparoscopic transabdominal preperitoneal mesh herniorrhaphy (n = 24) to open preperitoneal mesh herniorrhaphy (n = 25). RESULTS: When comparing unilateral repairs, the mean operation time was significantly (P < 0.01) shorter in the open group (55 min) than in the laparoscopic group (66 min). Pain on movement (P < 0.05) and pain on coughing (P < 0.01) receded more rapidly in the laparoscopic group. The median time before return to work or normal activity was 7 days (range 1-60) in laparoscopic and 5 days (1-30) in open repair. There were five (21%) complications associated with the laparoscopic procedure, while the open procedure resulted in two (8%) complications. After a median follow-up of 18 months the recurrence rate in the laparoscopic group was 13% and in the open group 8%. CONCLUSIONS: In this study the open method was associated with fewer complications and recurrences than the laparoscopic technique. Despite the decreased postoperative discomfort after laparoscopic repair, there was no significant difference in median time before return to work or normal activity. These results together with the higher cost of the laparoscopic procedure suggest that the open method is more suitable at least for unilateral hernias.

Comparison of N2O and CO2 pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain.

To study the possible benefits of N2O pneumoperitoneum, 40 patients scheduled for laparoscopic cholecystectomy for symptomatic cholelithiasis were randomized into either CO2-induced (n = 20) or N2O-induced (n = 20) pneumoperitoneum groups. The intensity of postoperative pain was assessed by the patients themselves using an visual analogue pain score scale. CO2 insufflation caused respiratory acidosis. The total amount of anesthetic enflurane needed was lower in the N2O than in the CO2 group (p < 0.041). The N2O group experienced less pain 1 hour (p < 0.040) and 6 hours (p < 0.017) postoperatively and the next morning. Serum cortisol and plasma adrenaline concentrations in the N2O group did not differ from those in the CO2 group. Patients with N2O pneumoperitoneum seem to have less pain without the side effects caused by CO2. The N2O pneumoperitoneum is a good alternative to the CO2 pneumoperitoneum, especially for prolonged laparoscopic operations in patients with chronic cardiopulmonary diseases.

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 (PSC), diagnosed in about 5% of patients with ulcerative colitis (UC), has been shown to be associated with pouchitis after ileal pouch-anal anastomosis. 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 changes in the ileal reservoir mucosa and clinical pouchitis. METHODS: Of the consecutive 81 UC patients treated with restorative proctocolectomy with ileal J reservoir at Tampere University Hospital between 1985 and 1991, 73 with peroperative liver biopsy were included. A peroperative 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 alone or by clinical criteria combined with the results of previous pouch endoscopies in all patients. RESULTS: Ten patients (14%) showed histologic features consistent with small-duct PSC on liver biopsy. Endoscopic retrograde cholangiography had previously been performed on four of these patients, and all four had large-duct PSC. Patients with cholangitis had significantly more severe chronic, but not acute, inflammation in the pouch mucosa than patients without cholangitis. At least one episode of pouchitis occurred in 30% of the patients without cholangitis as compared with 90% of the patients with cholangitis. Chronic pouchitis was more frequent in the group with cholangitis than in the group without it (70% versus 11%). CONCLUSIONS: The only means of detecting all UC patients with cholangitis is a liver biopsy. Cholangitis, either with the clinical syndrome of PSC or found on liver biopsy, seems to be a risk factor for chronic-type inflammatory changes in the pouch mucosa and for the development of pouchitis.

Y-V anoplasty combined with internal sphincterotomy for stenosis of the anal canal.

OBJECTIVE: To review the results of Y-V anoplasty combined with internal sphincterotomy in the treatment of anal stenosis. DESIGN: Retrospective study. SETTING: University hospital, Finland. SUBJECTS: 10 patients with stenosis of the anal canal. MAIN OUTCOME MEASURES: Improvement of symptoms and function. RESULTS: Nine patients improved postoperatively. Six of the patients had good results, three had fair results and one had a poor result. There were no postoperative complications. CONCLUSION: Y-V anoplasty combined with internal sphincterotomy is a safe and simple procedure that gives good results. We recommend its use to treat stenosis of the anal canal.

Effect of proctocolectomy on serum antineutrophil cytoplasmic antibodies in patients with chronic ulcerative colitis.

AIMS: To study the effect of proctocolectomy on the antineutrophil cytoplasmic antibody (ANCA) titres in association with ulcerative colitis. METHODS: Serum samples were taken from 15 patients with ulcerative colitis immediately before and at a mean of 24 months after proctocolectomy. Indirect immunofluorescence for ANCA and enzyme immunoassays for myeloperoxidase and proteinase-3 antibodies were employed. A liver biopsy was taken from every patient during the proctocolectomy, and serum liver enzyme activities were also determined. RESULTS: Before proctocolectomy, 13 of the 15 patients had perinuclear antineutrophil cytoplasmic antibodies (p-ANCA). Additionally, one patient had a low tire of classical cytoplasmic ANCA and one had granulocyte specific antinuclear antibodies. After proctocolectomy, the ANCA titres decreased in 10 patients, in two of whom they became negative. The titres remained the same in four patients with positive ANCA and increased twofold in one patient. Only one patient was proteinase-3 antibody positive and all 15 patients were myeloperoxidase antibody negative. The clinical condition improved in all patients, irrespective of the ANCA status after proctocolectomy. Seven patients, all of whom were positive for p-ANCA before proctocolectomy, had histological liver abnormalities. No correlation was observed between serum liver enzyme levels and ANCA staining patterns or titres. CONCLUSIONS: Proctocolectomy decreased the ANCA titres in the majority of our patients, suggesting that reduction of the inflammation or the available antigenic material modifies the immune disturbance related to ulcerative colitis.

Liver lesions found at colectomy in ulcerative colitis: correlation between histological findings and biochemical parameters.

AIMS: To classify lesions discovered at colectomy in patients with ulcerative colitis; to assess the importance of histological findings by correlating them with biochemical parameters. METHODS: Liver tissue specimens taken at colectomy from 59 patients with chronic ulcerative colitis were studied using light microscopy. The findings were compared with results of biochemical liver function tests. RESULTS: Abnormal laboratory findings were found in 12 patients with liver histology consistent with primary sclerosing cholangitis. Non-specific reactive hepatitis was observed in six patients, eight had fatty liver, and three minor non-specific parenchymal changes. Twenty nine patients had normal liver histology. The highest cholestatic serum enzyme activities were seen in two patients with sclerosing cholangitis. Cholangiography in these patients also revealed changes in the extrahepatic bile ducts. However, identical histological changes were also present in patients with only slightly abnormal or even normal liver enzyme activities. CONCLUSION: Biochemical tests of liver function do not reliably indicate the extent or severity of bile duct damage in ulcerative colitis, the assessment of which requires liver biopsy.

The effect of proctocolectomy on serum antibody levels against cow's milk proteins in patients with chronic ulcerative colitis, with special reference to liver changes.

BACKGROUND: The levels of antibodies against cow's milk proteins in ulcerative colitis (UC) were used to study whether mucosal inflammation leads to immune recognition, as a marker of enhanced permeability, of dietary proteins. A further purpose was to study the effect of proctocolectomy on the serum antibody levels against cow's milk proteins and their relation to biochemical and histologic liver abnormalities associated with ulcerative colitis. METHODS: Serum antibody levels against six cow's milk proteins, alpha-casein, alpha-lactalbumin (LA), beta-lactoglobulin A (LGA), beta-lactoglobulin B (LGB), bovine serum albumin (BSA), and whole milk powder (MP) were determined before and after (mean, 24 months) proctocolectomy in 15 patients with ulcerative colitis. Simultaneously, serum liver enzymes were analyzed. A liver biopsy specimen was also obtained at proctocolectomy. RESULTS: Before proctocolectomy IgA antibody levels were significantly increased against all antigens except BSA. Increased levels of IgM antibodies against LGA, LGB, and BSA were also detected. IgG antibodies were significantly increased only against LGA. After proctocolectomy IgA and IgM antibody levels decreased significantly (p < 0.05) against LGA, LGB, and LA, whereas IgG antibodies increased significantly (p < 0.01). In the patient group with abnormal liver histology (n = 9) the IgA antibodies to all cow's milk proteins were significantly higher (p < 0.02) than in the group with normal liver histology both before and after proctocolectomy. The IgA antibody levels showed a significant positive correlation with alanine amino-transferase and gamma-glutamyltransferase (r value from 0.460 to 0.721, p value from < 0.05 to < 0.01), but not with alkaline phosphatase. CONCLUSIONS: These results suggest that the inflamed mucosa in UC allows the antigenic contents of the bowel to escape. Proctocolectomy alters the antibody levels against certain milk proteins, which may serve as a model to suggest that proctocolectomy, probably by eliminating inflammation, may have positive effects by reducing the foreign pathogenic antigen and immune complex load.

Prevalence of hepatobiliary dysfunction in patients with ulcerative colitis.

The aim of this study was to estimate the prevalence of hepatobiliary dysfunction in a regional unselected group of ulcerative colitis (UC) patients. Five hundred and thirty-four patients were included in this study. Eighty-one per cent of them had never had abnormal alkaline phosphatase (ALP) values and 72% no abnormal alanine amino-transferase (ALAT) values. Thirty patients (6%) had had ALP values more than twice the normal (> 550 U/L) at least once during their disease. Furthermore, 24 (34%) out of 70 patients with routine liver biopsy at colectomy had changes in their liver histology, 13 (19%) of these also having ALP and ALAT values within normal range. Primary sclerosing cholangitis (PSC) had been diagnosed in 11 (2%) patients. All but one of the PSC patients had had ALP and ALAT values more than twice the normal. Almost 30% of all patients had had abnormalities in their liver biochemistry at least once during their disease. Normal liver biochemistry did not seem to exclude changes in liver histology. Although minor hepatobiliary dysfunction is common in patients with UC, more serious conditions such as PSC were found to occur in only 2% of patients.