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Liver Disease in Ulcerative Colitis: II. The Long-Term Effect of Colectomy

M. N. EADE, M.B., M.D., M.R.A.C.P.; W. T. COOKE, M.D., F.R.C.P.; and B. N. BROOKE, M.D., M.Chir.
[+] Article, Author, and Disclosure Information

Funds for equipment were provided by Smith, Kline & French Laboratories, Philadelphia, Pa.

Dr. Eade was supported in this study by a grant from the Medical Research Council, London, England.

▸Requests for reprints should be addressed to W. T. Cooke, M.D., Nutritional and Intestinal Unit, The General Hospital, Birmingham, England.

Birmingham, England

Ann Intern Med. 1970;72(4):489-497. doi:10.7326/0003-4819-72-4-489
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A follow-up study of liver disease was performed on 138 consecutive patients with ulcerative colitis who had colectomy in the period 1959 through 1963. Of the 117 survivors, 110 were seen personally and the remainder contacted after a 5-year mean follow-up interval. Detailed liver function tests showed elevation of serum alkaline phosphatase in 18% and increased sulfobromophthalein (BSP) retention in 26%. Preoperative elevations of alkaline phosphatase had been markedly reduced, whereas any new elevations were very minor. Except for four patients with cirrhosis, both alkaline phosphatase and BSP abnormalities at follow-up showed little correlation to observed histological abnormalities on follow-up biopsy. Follow-up liver biopsy after colectomy was obtained in 33 patients selected because of liver function abnormalities. Liver biopsy was also available in 23 additional patients from second-stage proctectomy or postmortem study. Comparison of this histological material with liver histology at colectomy in these patients showed arrest or regression of liver disease after panproctocolectomy. Progression of liver disease occurred only in three patients who had persistent "colitis" in relation to an ileorectal anastomosis. Because panproctocolectomy resulted in arrest or regression of liver disease in patients with ulcerative colitis this operation is considered to have a definite place in management of liver disease complicating ulcerative colitis.





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