| Abstract: | Clinical, haematological, biochemical, bacteriological, histological,and immuno-logical data of 100 patients with Crohn's diseasehave been examined with special reference to liver disease anddysfunction. Several significant points emerged from the clinical data. Therewas a high frequency of colonic involvement (57 per cent), andalso a very high proportion of patients (48 per cent) with systemiccomplications, the commonest systemic complications being iritis(19 per cent) and sacro-ileitis (15 per cent). Nearly three-quarters(71 per cent) of the patients had been operated on at some timeand 57 per cent had had one or more bowel resections. Localcomplications had occurred in 52 per cent of patients. Biochemical liver dysfunction was common, occurring in 26 (26per cent) patients, the BSP being the test most frequently abnormal.Two patients with established chronic liver disease had considerablebiochemical liver dysfunction, but about half the patients withlesser pathological changes in the liver had no biochemicalliver dysfunction. Of the 39 patients who underwent liver biopsy, 19 (19 per cent)had pathological changes in the liver, the commonest changesfound being pericholangitis (8 per cent), focal necrosis (6per cent), and fatty change (4 per cent). Only two patientshad chronic liver disease, one patient having chronic activehepatitis and the other portal cirrhosis associated with haemosiderosis. Culture of liver tissue for bacteria or L forms was uniformlynegative. Immuno-logical studies proved unrewarding in relationto liver disease and dysfunction in patients with Crohn's disease.However, two significant differences did emerge in comparingthe results of the immunological tests in ulcerative colitiswith those in Crohn's disease. Positive immunofluorescence teststo human colon were found in 12·7 per cent of patientswith ulcerative colitis, compared with only 2·3 per centof patients with Crohn's disease. There was also a significantdifference in IgM levels, with low values of IgM more frequentin Crohn's disease and high values more frequent in ulcerativecolitis; further research will be necessary to determine theunderlying reasons for this difference. The finding that the hepatic changes in Crohn's disease areremarkably similar to those in ulcerative colitis, both in frequencyand in type, leads to several possible explanations. First,ulcerative colitis and Crohn's disease may be different manifestationsof a single disease. Secondly, the liver disease and the otherremote complications, which are also similar in Crohn's diseaseand ulcerative colitis, may be a consequence of chronic inflammatorydisease of the intestine, irrespective of its exact nature.Thirdly, ulcerative colitis and Crohn's disease may both begeneralized diseases in which the brunt falls upon the intestinaltract. The aetiology of the hepatic lesions remains obscure but somedeductions can be drawn from the present data. From clinicalconsiderations, the overt liver disease appears to behave likea viral hepatitis which has become chronic. There is no evidenceto support the view that homologous serum hepatitis from bloodtransfusion is the significant factor. Drugs do not appear tobe of any great relevance. Immunological relationships are essentiallynegative. Portal bacteraemia appears to be an unlikely causeof the overt chronic liver disease encountered in the presentstudy. |
