Effect of transient obstructive cholestasis on liver histology: a cross-sectional study

• Published in: São Paulo medical journal Vol. 139; no. 4; pp. 351 - 363
• Main Authors: Mitsunaga, Thalita Mendes, Jimenez, Laísa Simakawa, Soares, Pedro França da Costa, Gestic, Martinho Antonio, Utrini, Murillo Pimentel, Chaim, Felipe David Mendonça, Callejas-Neto, Francisco, Chaim, Elinton Adami, Cazzo, Everton
• Format: Journal Article
• Language: English
• Published: Associação Paulista de Medicina - APM 01-08-2021; Associação Paulista de Medicina
• Subjects: MEDICINE, GENERAL & INTERNAL; Original
• ISSN: 1516-3180; 1806-9460; 1806-9460
• DOI: 10.1590/1516-3180.2020.0536.r1.1502021

BACKGROUNDThe role of transient obstructive cholestasis on liver histology remains undetermined. OBJECTIVETo investigate whether transient cholestasis impairs liver histology. DESIGN AND SETTINGCross-sectional study at a public university hospital (UNICAMP), Brazil. METHODS169 individuals undergoing cholecystectomy, with or without cholestasis. were enrolled. Histopathological findings were correlated with clinical and biochemical characteristics. RESULTSBiliary hepatopathy was more frequent in individuals with resolved cholestasis than in those with active obstruction or no jaundice (P < 0.01), as also were fibrosis and ductular proliferation (P = 0.02). Cholestasis was commoner in individuals with resolved obstruction than in those with no history (P < 0.01) or active cholestasis (P < 0.05). Biliary hepatopathy was associated with longer duration of cholestasis (P < 0.001) and higher bilirubin levels (P = 0.02) in individuals with active obstruction; with lower body mass index (P = 0.02) and longer cholestasis (P < 0.001) in individuals with resolved obstruction; and with longer cholestasis (P < 0.001) and longer interval between endoscopic retrograde cholangiopancreatography and surgery (P = 0.03) overall. In individuals with active obstruction, duration of cholestasis (R = 0.7; P < 0.001) and bilirubin levels (R = 0.6; P = 0.004) were independently correlated with cholestasis severity. Duration of cholestasis (R = 0.7; P < 0.001) was independently correlated with ductular proliferation severity. CONCLUSIONSTransient cholestasis was associated with significant histopathological changes, even after its resolution. Longer duration of obstruction correlated with greater severity of histopathological changes, especially cholestasis and ductular proliferation. This emphasizes the need for early treatment of obstructive cholestasis.