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Gastroenterology (Expert Forum)
cholangitis due to UC?
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
cholangitis due to UC?
by Julie__0__0, May 17, 1998 12:00AM
In 95' I was diagnosed with chronic ulcerative colitis,
and within four months had surgery to remove my large intestine.
(I now have a j-pouch). Even before my diagnosis of UC, I had
a burning type pain in my upper right quadrant. After my j-pouch
surgery this persisted, and after having a CCK that showed a 7%
ejection fraction, we decided to go ahead and have my gallbladder
removed thinking I had chronic acalculous cholecystitis, yet at
surgery there was only minimal chronic cholecystitis and no stones.
At the time of this surgery, my doctor injected a dye into my bile
ducts which showed them free of stones. He also took a biopsy of my
liver because in a previous ultrasound a benign tumor was found.
Anyway, the pathology report says that the fragment taken was distorted,
but a couple of times it says that fibrous tissue, suggestive of
interlobular septae -- but cirrhosis cannot be confirmed.
Since the gallbladder surgery, I did have a surgery (a year ago)
for a bowel blockage and there were several places of high density adhesions
found in my upper right quadrant. I'm taking propulsid right now,
because I've had distention in my upper abdomen and pain after eating.
I still have that burning pain where my gallbladdder was removed,
but it encompasses a greater area now, even to the area just under
the very edge of my right rib. Though the propulsid has helped,
I'm having to take larger doses as the weeks progress, and I find
the relief is not as great as it once was. Also, I have horrible
nausea, particularly after meals to the point where I vomit.
I've tried prilosec and zantac, so it appears that it's not related
to an ulcer. My doctor has mentioned that I've shown signs of
biliary disease, and sclerosing cholangitis is a manifestation of
UC. What test can I ask for to see if this is the problem? I've
had liver enzyme tests come back abnormal in the last year; I
believe it was the GGT that was elevated.
Sorry to be so lengthy. I know this is a lot to take in, but I
feel like I'm getting no where fast. By the way,
I'm a 32 year-old woman . . . going on 80.
Dear Julie,
Ulcerative colitis, although curable with a colectomy (removal of the colon) , is associated with a variety of extraintestinal manifestations which do not necessarily disappear after colectomy. Sclerosing cholangitis is a disease of the biliary system. The bile ducts become inflamed and scarred. This can lead to cholangitis (infections in the bile duct) and other complications. It occurs in about 4% of patients with ulcerative colitis and much less often in Crohn’s disease. Sclerosing cholangitis is more common in men. Its onset may precede the development of colitis by many years and its course does not parallel bowel disease activity. Colectomy does not alter the clinical course of cholangitis.
You stated that your GGT level was elevated. Usually the alkaline phosphatase is elevated in sclerosing cholangitis. Although sclerosing cholangitis can be diagnosed on a liver biopsy, the gold standard is to see narrowing of the bile ducts with a test called endoscopic retrograde cholangiopancreatography (ERCP for short). An ERCP is a test where a tube with a light is introduced into the stomach and small intestine. Once the area where the bile duct enters the intestine is identified, dye is placed into the bile ducts. A gastroenterologist usually performs this procedure.
I hope you find this information helpful. It sounds like you’ve had a rough time these past few years. I hope that your condition stabilizes and that you can begin to enjoy life again.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Zonca, one of our experts in Gastroenterology and Biliary Disorders.
HFHSM.D.-ym
*Keywords: ulcerative colitis, sclerosing cholangitis, ERCP
and within four months had surgery to remove my large intestine.
(I now have a j-pouch). Even before my diagnosis of UC, I had
a burning type pain in my upper right quadrant. After my j-pouch
surgery this persisted, and after having a CCK that showed a 7%
ejection fraction, we decided to go ahead and have my gallbladder
removed thinking I had chronic acalculous cholecystitis, yet at
surgery there was only minimal chronic cholecystitis and no stones.
At the time of this surgery, my doctor injected a dye into my bile
ducts which showed them free of stones. He also took a biopsy of my
liver because in a previous ultrasound a benign tumor was found.
Anyway, the pathology report says that the fragment taken was distorted,
but a couple of times it says that fibrous tissue, suggestive of
interlobular septae -- but cirrhosis cannot be confirmed.
Since the gallbladder surgery, I did have a surgery (a year ago)
for a bowel blockage and there were several places of high density adhesions
found in my upper right quadrant. I'm taking propulsid right now,
because I've had distention in my upper abdomen and pain after eating.
I still have that burning pain where my gallbladdder was removed,
but it encompasses a greater area now, even to the area just under
the very edge of my right rib. Though the propulsid has helped,
I'm having to take larger doses as the weeks progress, and I find
the relief is not as great as it once was. Also, I have horrible
nausea, particularly after meals to the point where I vomit.
I've tried prilosec and zantac, so it appears that it's not related
to an ulcer. My doctor has mentioned that I've shown signs of
biliary disease, and sclerosing cholangitis is a manifestation of
UC. What test can I ask for to see if this is the problem? I've
had liver enzyme tests come back abnormal in the last year; I
believe it was the GGT that was elevated.
Sorry to be so lengthy. I know this is a lot to take in, but I
feel like I'm getting no where fast. By the way,
I'm a 32 year-old woman . . . going on 80.
Dear Julie,
Ulcerative colitis, although curable with a colectomy (removal of the colon) , is associated with a variety of extraintestinal manifestations which do not necessarily disappear after colectomy. Sclerosing cholangitis is a disease of the biliary system. The bile ducts become inflamed and scarred. This can lead to cholangitis (infections in the bile duct) and other complications. It occurs in about 4% of patients with ulcerative colitis and much less often in Crohn’s disease. Sclerosing cholangitis is more common in men. Its onset may precede the development of colitis by many years and its course does not parallel bowel disease activity. Colectomy does not alter the clinical course of cholangitis.
You stated that your GGT level was elevated. Usually the alkaline phosphatase is elevated in sclerosing cholangitis. Although sclerosing cholangitis can be diagnosed on a liver biopsy, the gold standard is to see narrowing of the bile ducts with a test called endoscopic retrograde cholangiopancreatography (ERCP for short). An ERCP is a test where a tube with a light is introduced into the stomach and small intestine. Once the area where the bile duct enters the intestine is identified, dye is placed into the bile ducts. A gastroenterologist usually performs this procedure.
I hope you find this information helpful. It sounds like you’ve had a rough time these past few years. I hope that your condition stabilizes and that you can begin to enjoy life again.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Zonca, one of our experts in Gastroenterology and Biliary Disorders.
HFHSM.D.-ym
*Keywords: ulcerative colitis, sclerosing cholangitis, ERCP
Doctor's Answer
