Hepatobiliary manifestations following two-stages elective laparoscopic restorative proctocolectomy for patients with ulcerative colitis: A prospective observational study

Table 1 General characteristics of the studied patients, n (%)

General characteristics
Age (yr) (mean ± SD)	36 ± 8
Sex
Male	112 (67.1)
Female	55 (32.9)
Smoking	50 (29.9)
Family history of ulcerative colitis	35 (21.0)
Ulcerative colitis disease duration before surgery (mo)	39 (4 - 90)
Treatment of ulcerative colitis
Mesalazine	137 (82.0)
Sulphasalazine	30 (18.0)
Anti-TNF	21 (12.6)
Corticosteroids	65 (38.9)
Type of PSC1
Large duct PSC	83 (79.8)
Small duct PSC	21 (20.2)
Family history of PSC	14 (8.4)
Diagnosis and treatment of hepatobiliary manifestations
Diagnostic methods
ANCA	104 (62.3)
MRCP	106 (63.5)
ERCP	10 (6.0)
Liver biopsy	143 (85.6)
Ultrasound	60 (35.9)
Treatment
UDCA	106 (63.5)
LMWH	6 (3.6)
Steroid	2 (1.2)
Obeticholic acid	2 (1.2)
Sonar guided drainage	1 (0.6)
Fibrates	2 (1.2)
Azathioprine	1 (0.6)

¹Percentages calculated based on a total of 104 patients with PSC.

Data were presented as mean ± SD, median (min-max), or number (percentage).

Anti-TNF: Anti-tumour necrosis factor; PSC: Primary sclerosing cholangitis; ANCA: Antineutrophil cytoplasmic antibodies; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography; UDCA: Ursodeoxycholic acid; LMWH: Low-molecular-weight heparin.

Table 2 Laboratory and clinical findings before (immediately before surgery) and after surgery (at the end of the study), n (%)

		P value
High ALT
Before surgery	115 (68.9)	< 0.0011
After surgery	54 (32.3)
High AST
Before surgery	121 (72.5)	< 0.0011
After surgery	68 (40.7)
High alkaline phosphatase
Before surgery	100 (59.9)	< 0.0011
After surgery	63 (37.7)
High bilirubin
Before surgery	114 (68.3)	< 0.0011
After surgery	74 (44.3)
Pain
Before surgery	110 (65.9)	< 0.0011
After surgery	71 (42.5)
Jaundice
Before surgery	107 (64.1)	< 0.0011
After surgery	73 (43.7)
Pruritus
Before surgery	86 (51.5)	< 0.0011
After surgery	59 (35.3)
Fever
Before surgery	35 (21.0)	< 0.0011
After surgery	21 (12.6)
Fatty liver score
Before surgery	2 (1- 3)	< 0.0011
After surgery	1 (0-3)

¹Significant bilirubin (normal range < 20 mmol/L) alanine aminotransferase (ALAT) (normal range < 39 U/L, gamma-glutamyl transpeptidase (GGT) (normal range < 42 U/L), alkaline phosphatase (ALP) (normal range 60-275 U/L).

Data were presented as number (percentage) or median (min-max).

ALT: Alanine aminotransferase; AST: Aspartate transaminase ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transpeptidase; ALAT: Alanine aminotransferase.

Table 3 Factors affecting regression of hepatobiliary manifestations, n (%)

	Manifestations regression		P value
	Yes (n = 28)	No (n = 139)
Age (yr)	37 ± 7	36 ± 8	0.578
Sex
Males	21 (75)	91 (65.5)	0.327
Females	7 (25)	48 (34.5)
Smoking	9 (32.1)	41 (29.5)	0.780
Family history	8 (28.6)	27 (19.4)	0.278
UC duration (mo)	37 (7-81)	40 (4-90)	0.877
UC treatment
Mesalazine	22 (78.6)	115 (82.7)	0.601
Sulphasalazine	6 (21.4)	24 (17.3)
Anti-TNF	0 (0)	21 (15.1)	0.0281
Corticosteroids	5 (17.9)	60 (43.2)	0.0121
Hepatobiliary manifestations
Autoimmune hepatitis	1 (3.6)	0 (0)	NA
Fatty liver	18 (64.3)	10 (7.2)
Gall bladder stone	0 (0)	17 (12.2)
Liver abscess	0 (0)	1 (0.7)
Primary biliary cholangitis	1 (3.6)	1 (0.7)
PSC	0 (0)	104 (74.8)
Portal vein thrombosis	0 (0)	6 (4.3)
Reactive hepatitis	8 (28.6)	0 (0)
Type of PSC
Large duct PSC	0 (0)	83 (79.8)	NA
Small duct PSC	0 (0)	21 (20.2)
Family history of PSC	0 (0)	14 (10.1)	0.079
Hepatobiliary treatment	2 (7.1)	112 (80.6)	< 0.0011
High ALT	11 (39.3)	104 (74.8)	< 0.0011
High AST	16 (57.1)	105 (75.5)	0.0471
High Alkaline phosphatase	1 (3.6)	99 (71.2)	< 0.0011
High bilirubin	14 (50)	100 (71.9)	0.0231
Pain	20 (71.4)	90 (64.7)	0.496
Jaundice	13 (46.4)	94 (67.6)	0.0331
Pruritus	4 (14.3)	82 (59)	< 0.0011
Fever	1 (3.6)	34 (24.5)	0.0131
Fatty liver score	2 (1-3)	2 (2-3)	0.121

¹Significant.

Data were presented as mean ± SD, number (percentage), or median (min-max).

PSC: Primary sclerosing cholangitis; NA: Not applicable; Anti-TNF: Anti-tumour necrosis factor; UC: Ulcerative colitis; ALT: Alanine aminotransferase; AST: Aspartate transaminase.

Table 4 Multivariate logistic regression analysis to predict no regression of hepatobiliary symptoms

	OR (95%CI)2	P value
Steroid treatment	3.68 (1.29-10.45)	0.0151
High ALT	5.39 (2.19-13.28)	< 0.0011
High AST	2.59 (1.08-6.20)	0.0321
High ALP	73.59 (9.52-568.93)	< 0.0011
High bilirubin	2.72 (1.16-6.4)	0.0221
Jaundice	2.49 (1.07-5.8)	0.0341
Pruritus	9.75 (3.12-30.50)	< 0.0011
Fever	9.7 (1.25-75.03)	0.0291

¹Significant.

²Adjusted for age, gender, smoking, family history of UC, and UC duration; OR: Odds ratio; 95%CI: 95% confidence interval.

UC: Ulcerative colitis; ALT: Alanine aminotransferase; AST: Aspartate transaminase ALP: Alkaline phosphatase.