Factors influencing the prevalence of gallstones in liver disease: the beneficial and harmful influences of alcohol

Abstract

OBJECTIVE: The Patient Treatment File of the Department of Veterans Affairs comprises the computerized records of all inpatients treated in all Veterans Affairs hospitals distributed throughout the United States. This database was used to study the association between liver disease and clinically manifest cholelithiasis. METHODS: The computerized medical records of 38,459 patients with various forms of liver disease and 69,336 controls without the diagnosis were extracted from the annual files between 1990 and 1993. In a multiple logistic regression analysis, the occurrence of cholelithiasis served as the outcome variable, whereas different forms of liver disease and demographic characteristics, such as age, gender, and ethnicity, served as predictor variables. RESULTS: Among the control population, cholelithiasis was reported in 5.2% (3,571 of 69,336) of subjects. Cholelithiasis occurred in 7.5% (2,898 of 38,459) of patients with all liver disease, 9.5% (1,642 of 17,287) of patients with alcoholic liver cirrhosis, 13.7% (981 of 7,149) of patients with nonalcoholic liver cirrhosis, and 9.1% (66 of 728) of patients with alcoholic fatty liver (χ 2 = 1059, df = 4, p < 0.001). In the logistic regression, the odds ratios (ORs) for cholelithiasis associated with various forms of liver disease were: in all liver diseases combined (OR = 1.31, 95% CI = 1.25–1.38), in alcoholic liver cirrhosis (OR = 1.62, 95% CI = 1.54–1.72), in nonalcoholic liver cirrhosis (OR = 2.07, 95% CI = 1.94–2.21), and in alcoholic fatty liver (OR = 1.40, 95% CI = 1.11–1.75). Other risk factors for cholelithiasis besides liver disease were: female gender (OR = 1.43, 95% CI = 1.25–1.63), older age (OR = 1.28 per age decade, 95% CI = 1.26–1.30), Native American (OR = 1.38, 95% CI = 1.12–1.72) or Hispanic ethnicity (OR = 1.25, 95% CI = 1.15–1.35), and presence of diabetes mellitus (OR = 1.43, 95% CI = 1.35–1.52). A history of alcoholism exerted a protective influence (OR = 0.92, 95% CI = 0.87–0.97). CONCLUSION: Gallstone disease occurs frequently in hospitalized patients with chronic liver disease or liver cirrhosis and contributes to the burden of the disease.