Liver Disease in Crohn's Colitis

Twenty-one consecutive patients undergoing colectomy for Crohn's disease of total colon were studied, with particular emphasis on hepatic abnormality at colectomy and at 3- to 7-year follow-up. After colectomy there was a high incidence of recurrent Crohn's disease involving small bowel, regardless of initial small-bowel involvement. There were abnormalities of liver histology in 90% of the 20 operative biopsies, with 75% showing more than minor change. Cirrhosis, amyloidosis, and multiple hepatic granulomata were also noted. Elevated serum alkaline phosphatase was of value in detecting significant hepatic abnormality. Other tests were not as useful, being either too insensitive (such as serum bilirubin and serum transaminases) or too nonspecific (serum protein abnormalities and sulfobromophthalein retention). Blood transfusions, potentially hepatotoxic drugs, and previous hepatitis appeared unrelated to observed hepatic abnormalities. The frequency and type of hepatic abnormality encountered in Crohn's colitis was similar to that previously reported in ulcerative colitis and Crohn's disease predominantly affecting the small intestine.