Cholelithiasis in inflammatory bowel disease

Abstract

Cholelithiasis is considered an extraintestinal manifestation of Crohn's ileitis but has not been associated with ulcerative colitis. To evaluate if an increased risk of cholelithiasis exists in patients with ulcerative colitis, biliary ultrasonography was performed on 159 patients with inflammatory bowel disease, 114 patients with ulcerative colitis, and 45 patients with Crohn's disease. A control population of 2453 residents of the town near the authors' institute was also studied. An echographic survey of gallstones was performed on the control subjects, who participated in the Multicentrica Italiana Colelitiasi (MICOL). Seventeen patients with inflammatory bowel disease had gallstones (10.7 percent), 11 patients with ulcerative colitis had gallstones (9.6 percent), and 6 patients with Crohn's disease had gallstones (13.3 percent). In the control population, diagnosis of cholelithiasis was made in 239 subjects (9.7 percent). An estimate of the relative risk (odds ratio) of gallstones in ulcerative colitis and Crohn's disease and also in 4 subgroups formed on the basis of the extent of disease (total ulcerative colitis, partial ulcerative colitis, Crohn's disease with ileitis, Crohn's disease without ileitis) with respect to the general population was calculated using logistic regression with gallstones, sex, age, and body mass index as independent variables and inflammatory bowel disease as a dependent variable. The author's findings show an increased risk of gallstones in both patients with Crohn's disease (odds ratio = 3.6; 95 percent confidence limits = 1.2 - 10.4; P = 0.02) and patients with ulcerative colitis (odds ratio = 2.5; 95 percent confidence limits = 1.2 - 5.2; P = 0.01). The risk was highest in patients with Crohn's disease involving the distal ileum (odds ratio = 4.5; 95 percent confidence limits = 1.5 - 14.1; P = 0.009) and in patients with total ulcerative colitis extending to the cecum (odds ratio = 3.3; 95 percent confidence limits = 1.3 - 8.6; P = 0.01). These results confirm that there is an increased risk of gallstones in Crohn's ileitis but they show that there also exists an increased risk in patients with total ulcerative colitis.

Incidence and risk factors for gallstones in patients with inflammatory bowel disease

“…In particular, CD was associated with an approximately 2-fold relative risk (OR, 2.09; 95% CI, 1.20-3.64) of developing gallstones even after adjustment for age, sex, and BMI, which, together with genetic predisposition, constitute the well-known major risk factors for gallstones in the general population. 25,26 Our findings are in agreement with those reported in the only 2 casecontrolled prevalence studies conducted so far by Lorusso et al 7 and Lapidus et al, 10 in which the relative risk for GD in CD were 3.6 and 1.8, respectively. The lack of excess risk of developing GD in UC patients (OR, 1.33; 95% CI, 0.56-3.16) agrees with the results of two recent sonographic surveys on smaller UC populations, showing that these patients are not more frequently affected by GD in comparison with the general population.…”

“…Lorusso et al 7 and Jones et al 16 have found that the prevalence of GD is higher in UC patients than in the general population. By contrast, 2 recent sonographic surveys of small UC populations have shown that these patients are not more frequently affected by GD in comparison with the general population.…”

“…Unfortunately, many of the aforementioned studies included selected CD patients (such as only those undergoing surgical resection or with disease confined to the terminal ileum), which may explain the great differences of prevalence between series, and others enrolled only limited number of patients, thus limiting the precision of estimates. In addition, only four of the aforementioned studies have been case controlled; 1,4,7,10 however, two of those were not age-matched or sex-matched and comprised only a small series of patients. 4,7 Because many risk factors for gallstones in CD patients may be similar to those in the general population [i.e., age, sex, and body mass index (BMI)], the exact relative risk of developing GD for a CD patient compared with a sex-matched, age-matched, and BMI-matched IBD-free control has not yet been determined well.…”

“…1 In particular, the occurrence of gallstone disease (GD) in patients with Crohn's disease (CD) has been investigated in several studies, [2][3][4][5][6][7][8][9][10][11][12] with prevalence rates ranging from 13% to 34%. Unfortunately, many of the aforementioned studies included selected CD patients (such as only those undergoing surgical resection or with disease confined to the terminal ileum), which may explain the great differences of prevalence between series, and others enrolled only limited number of patients, thus limiting the precision of estimates.…”

Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease

“…4). On the other hand, the association between cholelithiasis and UC is controversial, 145,148 as there appeared to be no significant increase in the prevalence of gallstones in UC patients as compared with the general population. 148 The pathophysiology of increased incidence of cholelithiasis in CD is now well defined.…”