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Increased cholestatic enzymes in two patients with long-term history of ulcerative colitis: consider primary biliary cholangitis not always primary sclerosing cholangitis
  1. Erietta Polychronopoulou,
  2. Vasiliki Lygoura,
  3. Nikolaos K Gatselis,
  4. George N Dalekos
  1. Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
  1. Correspondence to Professor George N Dalekos, dalekos{at}


Several hepatobiliary disorders have been reported in ulcerative colitis (UC) patients with primary sclerosing cholangitis (PSC) being the most specific. Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, rarely occurs in UC. We present two PBC cases of 67 and 71 years who suffered from long-standing UC. Both patients were asymptomatic but they had increased cholestatic enzymes and high titres of antimitochondrial antibodies (AMA)—the laboratory hallmark of PBC. After careful exclusion of other causes of cholestasis by MRI/magnetic resonance cholangiopancreatography (MRCP), virological and microbiological investigations, a diagnosis of PBC associated with UC was established. The patients started ursodeoxycholic acid (13 mg/kg/day) with complete response. During follow-up, both patients remained asymptomatic with normal blood biochemistry. Although PSC is the most common hepatobiliary manifestation among patients with UC, physicians must keep also PBC in mind in those with unexplained cholestasis and repeatedly normal MRCP. In these cases, a reliable AMA testing can help for an accurate diagnosis.

  • inflammatory bowel disease
  • liver disease
  • ulcerative colitis

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  • Contributors GND and NKG had the original idea, designed the study and wrote the first draft of the manuscript. EP, VL and NKG collected and summarised the published literature and the data of the patients. GND and EP were the principal treating physicians, while VL made the laboratory investigation. GND and NKG made the final critical revision of the manuscript for important intellectual content. All authors have seen and approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.