Pericholangitis and Ulcerative Colitis

Abstract

Eighty two liver biopsies were obtained from 49 of 441 patients with ulcerative colitis. These 2 groups were compared and the sequential biopsies during life provided information about the evolution of the various lesions seen, Pericholangitis was the most common antemortem change; whereas severe fatty change occurred most frequently at postmortem. The clinical forms of pericholangitis (asymptomatic, cholestatic, cholangi-tic) are clinical variants of an identical pathologic change. Pericholangitis in ulcerative colitis is associated with changes in the portal lymphatics and venules, and in the hepatic lobule. Chronic pericholangitis may remain inactive (periportal fibrosis) and give rise to presinusoidal portal hypertension or develop activity with necrosis. During this stage, the picture resembles active chronic hepatitis which appears to have an association with these 2 lesions. In cases of pericholangitis post necrotic rather than Laennec''s cirrhosis occurs. Post necrotic cirrhosis in ulcerative colitis occurs as the end result of active chronic hepatitis or pericholangitis. The question of portal bacteria as a factor responsible for the acute changes and the possibility of an autoimmune process or chronic portal bacterial infection to explain the self perpetuating changes have been examined in the light of histologic findings.