Diabetes mellitus is associated with a higher rate of acute cholangitis among patients with common bile duct stones

Abstract

Common bile duct (CBD) stone is a commonly encountered disease that is associated with various clinical presentations ranging from the mild form of biliary colic to the severe complication of acute cholangitis. Recently, diabetes mellitus (DM) has been linked to the development of biliary diseases; however, no data regarding the association of DM with acute cholangitis development in the setting of CBD stone exist. The aim of the current study was to investigate whether DM represents a risk factor for acute cholangitis in patients with CBD stone. We performed a retrospective cross-sectional study from January 1, 2010 till June 1, 2020 of all patients presenting to Galilee Medical Center with various clinical presentations of documented CBD stone, including cholangitis, biliary pancreatitis, and biliary colic with abnormal liver enzymes. Overall, 687 patients were included in the final analysis. Among them, 101 patients (14.7%) had CBD stone associated with acute cholangitis (group A), as compared to 586 patients (85.3%) without acute cholangitis (group B). The average ages in groups A and B were 77.7 ± 13.6 and 62.5 ± 20.5 years, respectively ( P < .0001). The prevalence of DM was significantly higher in group A as compared to group B (52.5% vs 36.3%, P = .001). On univariate analysis, age (odds ratio [OR] 1.05, P < .0001), male gender (OR 1.54, P = .04), and DM (OR 1.92, P = .002) were associated with acute cholangitis development, and on multivariate logistic regression analysis, the correlation was preserved for DM (OR 1.93, 95% confidence interval 1.26–2.96, P = .002). DM showed a significant association with acute cholangitis development among patients with CBD stone. Identification of bile duct stones in diabetic patients is of paramount importance since early diagnosis and treatment might prevent further life-threatening complications.

Implications of Type 2 Diabetes Mellitus in Patients with Acute Cholangitis: A Systematic Review of Current Literature

“…The 14 selected manuscripts were published between 2011 and 2022 [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Most of the analyzed data were derived from retrospective cohort studies [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 ] with the exception of two investigations, namely one prospective study [ 36 ] and one case series [ 34 ]. The number of subjects who partook in these assessments ranged from 12 to 123,990 [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…Most of the analyzed data were derived from retrospective cohort studies [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 ] with the exception of two investigations, namely one prospective study [ 36 ] and one case series [ 34 ]. The number of subjects who partook in these assessments ranged from 12 to 123,990 [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Most of the research was carried out in Asia: two studies were conducted in Singapore [ 28 , 36 ], two in China [ 31 , 32 ], one in India [ 37 ], one in South Korea [ 35 ], and one in Israel [ 33 ].…”

“…The number of subjects who partook in these assessments ranged from 12 to 123,990 [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Most of the research was carried out in Asia: two studies were conducted in Singapore [ 28 , 36 ], two in China [ 31 , 32 ], one in India [ 37 ], one in South Korea [ 35 ], and one in Israel [ 33 ]. The remaining studies were conducted in the United States of America, i.e., two studies [ 27 , 38 ], and in Europe, i.e., Denmark [ 40 ], France [ 34 ], or Spain [ 30 ], or were the fruit of international collaboration [ 39 ].…”

“…The remaining studies were conducted in the United States of America, i.e., two studies [ 27 , 38 ], and in Europe, i.e., Denmark [ 40 ], France [ 34 ], or Spain [ 30 ], or were the fruit of international collaboration [ 39 ]. Most manuscripts focused on the potential role of DM as a risk factor for the development of AC or on its contribution to a worse prognosis (e.g., sepsis, recurrence) or to an elevated mortality in AC [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 38 , 40 ]. Two studies focused on the etiology of AC and sought to depict an association between the micro-organisms involved and the presence of DM [ 34 , 37 ].…”

“…Overall, T2DM increased the risk of AC onset in patients with choledocholithiasis, gallstone pancreatitis, patients who underwent ERCP, and subjects with T2DM who were treated with oral hypoglycemic agents. T2DM was associated with longer hospital stay, sepsis, higher risk of mortality, and more severe forms of AC as compared to non-diabetic individuals [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”