Liver disorders in patients with ulcerative colitis

A.E. Dorofeyev, A.A. Dorofeyeva

Abstract


Background. The article deals with the chronic inflammatory bowel diseases, in particular, the attention is paid to ulcerative colitis (UC). UC proceeds with the development of a number of extraintestinal lesions, among which a special place is given to the changes in the liver and bile ducts. In connection with this, a study was conducted to assess the prevalence, nature and clinical features of liver damage in patients with UC. Materials and methods. Under observation, there were 180 patients with UC confirmed endoscopically and morphologically. All patients underwent multimodal ultrasound examination of the liver, study of the biochemical signs of cytolysis and/or cholestasis with negative serological markers of viral hepatitis B, C, D and autoimmune hepatitis. Also, a biochemical study of the lipid spectrum of the blood was performed, and in patients with suspected autoimmune lesions of the liver — an analysis of the spectrum of the corresponding antibodies. Results. In 180 patients with UC, a liver damage was detected in 58 (32.2 %) persons. Parenchymal lesions of the liver were diagnosed in 40 (22.2 %) UC patients, and changes in the bile ducts — in 18 (10.0 %) patients with UC. Nonalcoholic steatohepatitis (NASH), autoimmune hepatitis (AH) and primary biliary cirrhosis (PBC) of the liver were detected in 40 (69.0 %) patients with UC, and lesions of extra- and intrahepatic bile ducts and gall bladder — in 18 (31.0 %). Among the parenchymal lesions of the liver, NASH dominated (53.5 %). AH was diagnosed in 8.6 % of patients, PBC — in 5.2 % of patients with UC. All patients with UC and NASH, in addition to the basic UC therapy, received the preparation of essential phospholipids in a daily dose of 1,800 mg (2 capsules 3 times a day) for three months. After the end of treatment, only 2 (6.5 %) patients had minor complaints. Prior to treatment, a significant increase in aspartate aminotransferase and alanine aminotransferase by 2.3 and 2.2 times, respectively, was observed in all the examined patients, in combination with 3.7 times increase in gamma-glutamyl transpeptidase compared with the norm, which may indicate a moderate cytolysis syndrome. After the treatment, patients showed a tendency to normalize the enzymatic status, although the indices remained elevated in comparison with the norm. Conclusions. Thus, liver damage was detected in 32.2 % of patients, predominantly in the advanced forms, with a moderate and severe course and high activity of UC. For the treatment of NASH in patients with UC, it is advisable to use essential phospholipids.

Keywords


nonspecific ulcerative colitis; nonalcoholic steatohepatitis; essential phospholipids

References


Aruin LI, Kapuller LL, Isakov VA. Morfologicheskaya diagnostika boleznei zheludka i kishechnika [Morphological diagnostic of gastric and bowel diseases]. Moskow: Triada-X; 1998. 496p. (in Russian).

Vorobiov GI, Halif IL, Malahova NS, Kapuller LL, Veselov VV, Mihaylova TL. Endoscopic and morphological features of the large bowel mucosa in patients with distal ulcerative colitis. Rossiiskii zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2006;16(1):80-86. (in Russian)

Dorofeyev AE, editor. Diagnostika i lechenie zabolevaniy pishevaritelnogo trakta [Diagnostic and treatment gastrointestinal diseases]. Donetsk: Nord-Press; 2009. 366p. (in Russian).

Yoffe AY, Zadorojnaya TD. Immunohistochemical features of proliferation and apoptosis markers in patients with ulcerative colitis. Laboratornaia diagnostika. 2015;1(31):50-53. (in Russian).

Kostyukevich SV, Anichkov NM, Ivanova BF, Oreshko LS, Kudryashova GP, Medvedeva OA, Smirnova OA. Endocrine cells of rectal epithelium in health, in nonspecific ulcerative colitis and irritable colon syndrome in the treatment with prednisolone and salofalk and in the absence of treatment. Arkhiv patologii. 2004;4:23-27. (in Russian).

Linevskii YuV, Linevskaya KYu, Voronin KA. Crohn's disease: practical aspects of the problem. Novosti Meditsiny i Farmatsii. 2009;304:43-50. (in Russian)

Mayanskii AN, Mayanskii DN. Ocherki o neytrofile i makrofage [Essays on the neutrophil and macrophage]. Novosibirsk: Nauka; 1983. 283p. (in Russian).

Filin VA, Salmova VS, Vartopetova EE. Modern aspects of the etiology and pathogenesis of nonspecific ulcerative colitis. Pediatriya. 2000;6;95-99. (in Russian).

Geboes K, Riddell R, Ost A, Jensfelt B, Persson T, Löfberg R. A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut. 2000 Sep;47(3):404-9. doi: 10.1136/gut.47.3.404.

Geboes K. Pathology of inflammatory bowel disease (IBD): variability with time and treatment. Colorectal Dis. 2001;3(1):2-12. PMID: 12791013.

Heliö T, Halme L, Lappalahen M, et al. CARD 15/ NOD 2 gene variants are associated with familially occurring and complicated forms of Crohn’s disease Gut. 2003;52(4):558-62. PMID: 12631669.




DOI: https://doi.org/10.22141/2308-2097.51.2.2017.101701

Refbacks

  • There are currently no refbacks.


Copyright (c) 2017 GASTROENTEROLOGY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru