Hepatobiliary Alterations in Ulcerative Colitis: A Report from a Tertiary Care Centre in Odisha

Background and Aim: Hepatobiliary manifestations are amongst the most important extraintestinal manifestations in chronic ulcerative colitis patients. There is paucity of data on hepatobiliary alterations in ulcerative colitis patients from India.The study was carried out to evaluate the hepatobiliary alterations in ulcerative colitis patients admitted to a tertiary care centre in Odisha. Methods: Consecutive patients 0f Ulcerative colitis admitted to Gastroenterology Department SCB Medical College, Cuttack from 0ct 2013 to April 2015 were included in the study. Patients with history of liver diseases were excluded. All patients were subjected to clinical examination, liver function tests and ultrasonography for evaluation of hepatobiliary alterations.MRCP was performed in selected patients. Controls were recruited from healthy subjects (n=100) Results: A total of 112 patients [73(65.1 %%) male; 39(34.9%) female] with ulcerative colitis were included. The mean age and BMI were 40.2±14.01years and 21.3±3.5kg/m2 respectively. Patients with mild, moderate and severe disease activity were 22(19.6%), 67(59.8%) and 23(20.5%) respectively. The median duration of illness was 24 months (IQR: 6.5-48). Extra intestinal manifestations were found in 68 patients(60.7%).40(35.7%) patients had arthralgia,6(5.3%) had arthritis, 13(11.6%) had episcleritis,2(1.7%) had stomatitis, 3(2.6%) had Erythematic Nodosum, 1(0.9%) had pyoderma Gangrenosum. 60 (53.8%) patients developed hepatobiliary alterations.2(1.7%) had jaundice, pruritus and clay colored stool in whom MRCP revealed primary sclerosing cholangitis. 22(19.6%) had hepatic steatosis, 42(37.5%) had asymptomatic transaminitis, 17(15.1%) had elevated alkaline phosphatase and 67(60%) had hypoalbuminmia.In control groups 17(17%) had hepatic steatosis,28(28%) had transaminitis, 8(8%) had elevated alkaline phosphatase. Conclusion: The study revealed that approximately 61% of Ulcerative colitis patients had extra intestinal manifestations.Hepatobiliary alterations are the most common (53.5%) extra intestinal manifestations in Ulcerative colitis and asymptomatic transaminitis is the most common hepatobiliary alterations in the patients with Ulcerative colitis in the present study. Key Words: Inflammatory bowel disease (IBD); Chronic ulcerative colitis (CUC); CRP(C-Reactive protein); Primary sclerosing cholangitis(PSC); Autoimmune hepatitis (AIH); ALT(Alanine transaminase) Autoimmunesclerosingcholangitis (ASC); ALP (Alkaline transferase); Gamma Glutamyl Transferase (GGT); pANCA(peri nuclear anti neutrophilic antibody);