The clinical
features of 61 patients with sclerosing cholangitis were reviewed. This
group included 23 patients with biliary tract calculi, commonly considered
as excluding the diagnosis of primary sclerosing cholangitis. The aim of
this study was to compare these 23 patients (group A) with 38 patients
with sclerosing cholangitis free of calculi (group B). Both groups had
the following features in common: (i) age at presentation, (ii) incidence
of inflammatory bowel disease, (iii) extent of radiological disease, (iv)
prevalence of HLA-B8 and DR3 haplotype, (v) incidence of cholangiocarcinoma,
and (vi) progression to hepatic transplantation (mean follow up 49.9 months).
All patients in group A were symptomatic at diagnosis compared with 23
of the 38 patients (61%) in group B. Recurrent ascending cholangitis occurred
in 12 patients in group A (52%) and two patients (5%) in group B. The similarity
between the two groups was maintained when the nine patients in group A
who developed calculi after sclerosing cholangitis was diagnosed were excluded.
It is concluded that choledocholithiasis is part of the spectrum of primary
sclerosing cholangitis and that it is not necessary to invoke choledocholithiasis
as the initial lesion of the bile ducts in such patients.
Texte | Bibliographie |