Risk Factors For Gallstones Research Articles

Symptomatic gallstones and HIV in black South African women: Changing trends of gallstone disease?

BackgroundThe incidence of metabolic disorders in human immunodeficiency virus (HIV) endemic settings is a prevailing burden in developing countries. Cholesterol homeostasis and fat metabolism are altered by HIV and antiretroviral therapy (ART), thereby possibly contributing to complications such as gallstone formation.ObjectivesThe aim of this study was to evaluate established risk factors for the formation of cholesterol gallstones in black South African women living with HIV (WLHIV).MethodA case series study was conducted of all black South African women undergoing cholecystectomy for gallstone disease over a 1-year period at King Edward VIII Hospital, Durban, South Africa. Age, body mass index (BMI), family history of gallstones, oestrogen exposure and lipograms were compared between WLHIV and uninfected women. Categorical variables were tested using either the Fisher’s exact test or Pearson’s chi-square test. Means were compared using independent t-tests. For non-normally distributed data, the Mann–Whitney U test was used. Statistical tests were two-sided, and p-values of less than 0.05 were considered statistically significant.ResultsA total of 52 patients were assessed, 34 HIV-uninfected and 18 WLHIV. The median age of WLHIV versus the uninfected women was 35 and 50 years, respectively, (p = 0.015). A statistically significant number of uninfected women were in the overweight/obese category (BMI > 25 kg/m2) compared to the normal weight category (BMI < 25 kg/m2) (p < 0.001). The number of obese WLHIV did not reach statistical significance.ConclusionThe age of occurrence of gallstone disease amongst black South African WLHIV was significantly lower and fewer women were obese compared with the uninfected women with gallstone disease. These findings differ from known gallstone risk factors in other populations and in uninfected black South African women. This could be attributed to the metabolic alterations caused by HIV infection itself and/or to the long-term use of ART. Larger cohort studies are required to elucidate the role of HIV and ART in cholestatic disease.

Gallstones in pregnancy.

Gallstone disease is the most common gastrointestinal disease in developed countries and is present in up to 15% of the population. Owing to the increased risk factors for gallstones in pregnancy, it is the second most common non-obstetric emergency, affecting up to 12% of pregnant women with a risk of recurrence. Up to 3% of pregnant women in America require a cholecystectomy in the first year after delivery. Gallstone disease has a high risk of developing associated complications, and maternal mortality can be up to 37% if the patient develops gallstone pancreatitis. Endoscopic retrograde cholangiopancreatography and cholecystectomy can be performed safely in the second trimester when benefits outweigh the risks. However, if the patient is able to be managed conservatively, then a cholecystectomy should be performed in the postnatal period to avoid further recurrences and complications. Despite this, there is currently no national UK guidance on how to manage gallstones and related diseases during pregnancy.

High Levels of Serum Triglyceride, Low-density Lipoprotein Cholesterol, Total Bile Acid, and Total Bilirubin are Risk Factors for Gallstones.

This study aimed to identify the risk factors for gallstone disease in the Hakka population in the Meizhou area of China. In total, 816 patients with gallstone disease and 818 control participants were included in the study, and their serum lipid levels were measured. Data on age, gender, and risk factors for gallstone disease (such as smoking and drinking history and the prevalence of hypertension) were recorded. Of the 1,634 enrolled individuals, age 13 - 101 years, 727 were men and 907 were women. Serum triglyceride (TG) (p < 0.001), low-density lipoprotein-cholesterol (LDL-C) (p = 0.043), total bile acid (TBA) (p < 0.001), and total bilirubin (T-BIL) (p < 0.001) levels showed significant differences between the patients and controls. However, age, the proportion history of drinking and smoking; the prevalence of hypertension and diabetes mellitus; and serum levels of total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), apolipoprotein A1 (Apo-A1), apolipoprotein B (Apo-B), and Apo-A1/Apo-B were similar between the two groups. The frequencies of gallstones in the common bile duct (χ2 = 13.909, p < 0.001) and intrahepatic bile ducts (χ2 = 8.289, p = 0.004) showed significant differences between male and female patients, but the distribution of gallstones of different sizes was similar between the two groups. Serum TBA (p < 0.001) and T-BIL (p < 0.001) levels were higher in patients with gallstones in the common bile duct than in those with gallstones in the gall bladder and intrahepatic bile ducts. Logistic regression analysis indicated that participants with high serum TG, LDL-C, TBA, and T-BIL levels had a significantly higher risk of gallstone disease. High serum levels of TG, LDL-C, TBA, and T-BIL are found to be the main risk factors for gallstone formation in our study.

Síntomas prevalentes y factores de riesgo de litiasis biliar en pacientes pediátricos en un hospital de referencia

Síntomas prevalentes y factores de riesgo de litiasis biliar en pacientes pediátricos en un hospital de referencia

Biliary adverse events in acromegaly during somatostatin receptor ligands: predictors of onset and response to ursodeoxycholic acid treatment

PurposeSomatostatin receptor ligands (SRL) are the first-line medical treatment for acromegaly. Gallbladder alterations are one of most important SRL side effect, but according to some authors growth hormone hypersecretion itself is a risk factor for gallstones. This single center, longitudinal retrospective study evaluated the incidence and the predictors of biliary adverse events (BAE) in acromegaly during SRL therapy and their response to ursodeoxycholic acid (UDCA).Methods91 acromegaly patients with indication to SRL were enrolled. Evaluations of acromegaly activity (GH, IGF-I, IGF-I/ULN) and metabolic profile were collected before starting treatment, yearly during follow-up and at BAE onset. In patients developing BAE we searched for predictors of UDCA effectiveness.Results61.5% of patients developed BAE (58.9% cholelithiasis; 41.1% only sludge). IGF-I and IGF-I/ULN proved to be positive predictor of BAE, which occur about 5 years after SRL starting. None of metabolic markers proved to be associated with BAE. Only five patients (5.5%) underwent cholecystectomy for symptomatic cholelithiasis. 71% of patients started UDCA treatment, achieving regression of BAE in 60% of cases (88% in patients developing only sludge and 30% in patients affected by cholelithiasis, p < 0.001). BMI and obesity were negative predictors of UDCA efficacy. In 50% of the subjects BAE resolved after 36 months of therapy with a lower rate if cholelithiasis was present.ConclusionBiliary stone disease is a frequent SRL adverse event, although it is often symptomless. Ultrasound follow-up mainly in the first 5 years of therapy, early UDCA starting and proper lifestyle represent a valid strategy in their detection and management.

Gallstones - review

The prevalence of gallstones is 20 % making it one of the most common causes for admissions to surgical wards. It seems that admissions and operations for gallstone disease are increasing. Gallstones are formed in the gallbladder but can also form in the biliary tree and most are made of cholesterol which is absorbed from the diet. Risk factors for gallstones and gallstone related disease are for example female gender, obesity and rapid weight loss. Most patients with gallstones never experience any symptoms but the risk of presenting with complications related to gallstones is two percent per year. Patients with gallstones can present with pain or other more serious complications that demand surgical treatment and follow-up. This article will cover pathophysiology, complications, diagnosis and treatment of gallstone disease.

Gallstones in Egyptian infants and children: risk factors, complications and outcome: a single center experience

BackgroundThe widespread use of abdominal ultrasonography in children documented increased detection rate of gallstones. The aim of this study was to assess the possible risk factors of gallstones and to detect the complication rate and outcome of the disease in Egyptian infants and children from a hepatologist perspective. This prospective study included 35 cases, with ultrasound-detected gallstones, who presented to the Pediatric Hepatology Unit from July 2015 to October 2017. All patients were initially evaluated by full history, general and abdominal examination, laboratory assessment, and ultrasound findings to detect possible risk factors of gallstones. Management approach was individualized for each patient according to his/her condition, and the patients were followed up at 3 months interval.ResultsThe patients’ ages ranged from 3.5 months up to 17 years. The median age of gallstone detection was 2 years. Gallstones were symptomatic in 62.9% with abdominal pain in 51.4%. Complications in the form of choledocholithiasis were detected in 7 patients (20%). Laparoscopic cholecystectomy was done for 7 patients while conservative management was applied for 24 patients. Complete resolution occurred in 8.3% and partial resolution in 33.3%. Chronic hemolytic anemia was the most commonly identified risk factor for gallstones. Patients needed surgical intervention had significant higher serum cholesterol and LDL levels (P = 0.006 and P = 0.002 respectively).ConclusionRisk factors for gallstones could be identified in most of pediatric cases. Symptomatic presentation is common among the pediatric population. Conservative management is recommended for asymptomatic cases of gallstones in children. Laparoscopic cholecystectomy is a safe and recommended procedure for complicated and symptomatic cases of gallstones.

Serum lipid levels are the risk factors of gallbladder stones: a population-based study in China

BackgroundGallstones are the cause of a majority of biliary tract discomfort. Although many community-based studies have addressed the risk factors for gallstone disease (GSD), little is known about GSD prevalence and risk factors in Chinese populations.MethodsFrom January 2014 to January 2015, participants (N = 2,068,523) were recruited by Meinian Onehealth Healthcare Co., Ltd. They received a physical examination, and GSD was determined by ultrasound.ResultsThe prevalence of GSD was 8.1%. Risks of GSD were similar between males and females in all age groups. Risk factors for gallstones include body mass index, waist circumference, waist-to-hip ratio, and physical activity, as well as biological factors such as age, sex, and elevated blood lipid levels. Serum lipid levels of GSD were statistically different from controls in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (H-DL), low-density lipoprotein cholesterol (LDL), and apolipoprotein B (APOB). Furthermore, TC > 5.00 mmol/L, TG > 1.39 mmol/L, HDL < 1.19 mmol/L, LDL > 3.04 mmol/L, and APOB > 0.97 mmol/L were risk factors for gallstones.ConclusionsSerum lipid levels are associated with GSD. TC, TG, LDL, and APOB are risk factors, while HDL is a protective factor.

Association analysis of testosterone, dehydroepiandrosterone and cholelithiasis in transitional menopausal women

Objective To investigate the relationship between testosterone, dehydroepiandrosterone (DEHA) and cholelithiasis among women in climacteric transition period. Methods A total of 2 127 women aged 40~55 were included from the Study of Women's Health Across the Nation. Individuals were divided into gallstone group (n=129) and control group (n=1 998). Serum testosterone, DEHA and other clinical indicators were measured. Mann-Whitney U test was used to compare the averages of continuous variables between groups. Logistic regression was used to analyse the associations between testosterone and DEHA and cholelithiasis. Results The gallstone group had higher testosterone, systolic blood pressure, BMI, waist circumference, hip circumference, triglyceride, C-reactive protein, and lower DHEA, sex hormone binding globulin and high density lipoprotein (P<0.05). After fully adjusting the covariates, testosterone and DEHA levels were correlated with gallstone occurrence, OR (95% CI) were 1.010(1.005~1.015) and 0.994 (0.991~0.997), respectively. In multivariate logistic regression, testosterone may be independent risk factors for gallstones, OR (95% CI) were 1.012(1.007~1.016). DEHA may be independent protective factors for the end of gallbladder, OR (95%CI) were 0.994 (0.991~0.997). Conclusion Testosterone was positively correlated with gallstone risk and DEHA was negatively correlated with gallstone risk in transitional menopausal women. Key words: Testosterone; Dehydroepiandrosterone; Cholelithiasis; Menopause; Causality

Strong association between metabolically-abnormal obesity and gallstone disease in adults under 50\u2009years

BackgroundAge, obesity, and metabolic syndrome are known risk factors for gallstones; however, the combined impact of these different risk factors on gallstone formation has not yet been examined.MethodsThis retrospective, cross-sectional study involved 3190 participants, including 207 participants (6.5%) with gallstones and 986 (30.9%) with metabolic syndrome. Participants were divided into four phenotypes according to metabolic syndrome and obesity status: 1378 participants were metabolically healthy and non-obese (MHNO); 826 were metabolically healthy but obese (MHO); 185 were metabolically abnormal but not obese (MANO); and 801 participants were metabolically abnormal and obese (MAO).ResultsThe MAO and MANO phenotypes had more gallstones than the MHO and MHNO phenotypes, regardless of age (< 50 or ≥ 50 years old). Multivariate analyses showed that phenotype was an independent risk factor for gallstones in participants < 50 years old (odds ratio (OR) = 1.73, 95% confidence interval (CI) = 1.32–2.28). Younger participants also had a higher risk of gallstones in the MAO (OR = 5.41, 95% CI = 2.31–12.66), MANO (OR = 3.18, 95% CI = 0.86–11.75), and MHO (OR = 2.17, 95% CI = 0.90–5.22) phenotypes than the MHNO phenotype.ConclusionsOur retrospective results demonstrate an increased association of gallstones in younger people (< 50 years old) with metabolic syndrome and obesity.

Risk assessment of gallstone among indoor patients of chronic liver diseases secondary to Hepatitis C.

Introduction: Gallstones (GS) are widely reported as the major cause of mortality and morbidity globally.1 The frequency of GS in patients with chronic liver disease (CLD) is considerably higher than in the general population.1-7 Moreover, prevailing risk of gallstone is associated with disease frequency and severity in advance stages of CLD.1,3 The predictable local incidence of gallstones in CLD patients is approximately 24-31%.6-7 HCV is presumed to be the major cause of CLD in the local settings6-7. Despite high prevalence of GS and HCV CLD in our population, the occurrence of GS in HCV CLD cases has not been assessed so far. Objective: To assess gallstone disease in indoor patients of chronic liver diseases secondary to Hepatitis-C.Methodology: This cross-sectional study was carried out at Department of Gastroenterology, Liaquat National Hospital (LNH), Institute for postgraduate medical studies and health sciences, Karachi from January 2013 to July 2013. Totalof145 patients of chronic liver disease (CLD) secondary to Hepatitis C Virus (HCV) of either gender, regardless of duration of disease, having age more than 30 years were selected purposively. Structured questionnaire used for data collection. Ultrasonography was done to diagnose gallstones. The routine investigations such as platelet count, anti HCV antibodies, and prothrombin time (PT) were performed. SPSS version 20 was used to analyze data. Variables like gallstone was presented through percentages and frequencies, age as mean and SD. After stratification of age, gender and severity of liver disease, chi-square test was applied and p-value less than 0.05 was considered statistically significant.Results: The mean age of patients (n=145) was 54.8±9.4 years, whereas mean of males was 53.9±9.3 years and females were 56.2±9.5years. Among total cases86(59.3%) were males and59(40.7%) were females. The gallstones in male patients (n= 30, 58.8%) was higher than female patients (n=21, 41.2%). However, this difference with regards to gender, was not statistically significant (p-value=0.9). The Child-Pugh score with gallstones patients was (10.0±2.1) slightly higher than patients without gallstone (10.7±2.1). In patients with gallstone, Child’sPughclass-Cwasfoundin51(54.3%) patients, class-Bin37(39.4, %) and class-A in 6 (6.3%) patients.&#x0D; Conclusion: HCV infection is independent risk factor for gallstones in cirrhotic patients. Laparoscopic cholecystectomy in Child-Pugh A and B patients with symptomatic gallstone disease is a safe procedure.&#x0D; Keywords: Gallstones, HCVCLD, Child-Turcotte-Pugh, Cholecystectomy

The effect of concomitant cholecystectomy and sleeve gastrectomy on morbidity in high-risk obese patients with symptomatic gallstones.

IntroductionObesity is an independent risk factor for gallstones. In obese patients, gallstone is more symptomatic than in non-obese people.AimTo present the early results of laparoscopic sleeve gastrectomy (LSG) and concomitant cholecystectomy (CC) performed in patients with symptomatic gallstone accompanied by at least one additional systemic disease to obesity and to investigate its effect on morbidity.Material and methodsPatients undergoing sleeve gastrectomy for morbid obesity between January 2016 and August 2018 were retrospectively studied. Twenty-seven patients who underwent laparoscopic sleeve gastrectomy and concomitant cholecystectomy due to symptomatic gallstone stones were included in this study. The patients were divided into two groups according to the applied surgical technique: laparoscopic sleeve gastrectomy and concomitant cholecystectomy (n = 27) and laparoscopic sleeve gastrectomy (n = 70). The results of an additional operation on these patients and their perioperative complications were evaluated.ResultsA total of 97 patients were included in the study. The mean age of the patients was 40.58 ±10.36 years. There was no statistically significant difference between groups in terms of complications (p = 0.669). The difference in the duration of the operation was statistically significant (p < 0.001).ConclusionsConcomitant cholecystectomy may be presented as an alternative surgical procedure due to the demonstration that concomitant cholecystectomy can be performed safely in comorbid obese patients, with a risk of becoming symptomatic in the rest of life at a certain rate, and low risk of complications in asymptomatic patients.

Gallstones and incident colorectal cancer in a large pan-European cohort study.

Gallstones, a common gastrointestinal condition, can lead to several digestive complications and can result in inflammation. Risk factors for gallstones include obesity, diabetes, smoking and physical inactivity, all of which are known risk factors for colorectal cancer (CRC), as is inflammation. However, it is unclear whether gallstones are a risk factor for CRC. We examined the association between history of gallstones and CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a prospective cohort of over half a million participants from ten European countries. History of gallstones was assessed at baseline using a self-reported questionnaire. The analytic cohort included 334,986 participants; a history of gallstones was reported by 3,917 men and 19,836 women, and incident CRC was diagnosed among 1,832 men and 2,178 women (mean follow-up: 13.6 years). Hazard ratios (HR) and 95% confidence intervals (CI) for the association between gallstones and CRC were estimated using Cox proportional hazards regression models, stratified by sex, study centre and age at recruitment. The models were adjusted for body mass index, diabetes, alcohol intake and physical activity. A positive, marginally significant association was detected between gallstones and CRC among women in multivariable analyses (HR = 1.14, 95%CI 0.99-1.31, p = 0.077). The relationship between gallstones and CRC among men was inverse but not significant (HR = 0.81, 95%CI 0.63-1.04, p = 0.10). Additional adjustment for details of reproductive history or waist circumference yielded minimal changes to the observed associations. Further research is required to confirm the nature of the association between gallstones and CRC by sex.

Genetics of gallstone disease.

Gallstone disease (GD) belongs to the most frequent disorders in gastroenterology and causes high costs in our health-care systems. Gallstones are uncommon in children but frequent in adults, in particular in women, and are triggered by exogenous risk factors. Here, we summarize the current knowledge concerning the contribution of inherited predisposition to gallstone risk. In this review, we present the current data and recent research on the genetics of gallstone disease. Several GD-predisposing gene variants have been reported, with most prominent effects being conferred by a common variant (p.D19H) of the hepatic and intestinal cholesterol transporter ABCG5/G8. A smaller group of patients might develop gallstones primarily due low phosphatidylcholine concentrations in bile as a result of loss-of-function mutations of the ABCB4 transporter (low phospholipid-associated cholelithiasis syndrome). Regardless of the origin, the risk factors for gallstones lead to the supersaturation of bile with insoluble compounds, in particular cholesterol. As result, cholesterol stones develop and present the most frequent type of gallstones. Laparoscopic cholecystectomy with low morbidity and mortality is currently the most common and effective method for the therapy of symptomatic gallbladder stones. Gallstone disease represents a multifactorial condition and previous studies have identified the major genetic contributors to gallstone formation. The increasing knowledge about the pathomechanisms of hepatobiliary metabolism and GD as well as the identification of additional risk factors might help to overcome the current invasive therapy by specific lifestyle intervention and precise molecular treatment.

Hepatitis C Virus Infection Increases Risk of Gallstone Disease in Elderly Chinese Patients with Chronic Liver Disease

We investigated possible links between the etiology of liver disease and gallstone risk in Chinese patients with chronic liver disease (CLD). We compared the outcomes of 267 Chinese CLD patients with gallstones and those of a control group of 1,015 CLD patients without gallstones. Logistic regression analyses adjusting for demographic features and other gallstone risk factors revealed that liver cirrhosis increased the risk of gallstone development twofold [adjusted odds ratio (AOR); 95% confidence interval (95% CI): 2.343 (1.710–3.211)]. HCV infection increased gallstone risk 1–2-fold [AOR; 95% CI: 1.582 (1.066–2.347)] higher than did HBV infection. Multivariate analyses of the risk of developing gallstones in patients with liver cirrhosis after an HCV or HBV infection yielded an estimated AOR (95% CI) of 1.601 (1.063–2.413) in patients with an HCV infection. In elderly patients with CLD (≥60 years of age), gallstone risk also increased significantly after an HCV infection [AOR (95% CI): 2.394 (1.066–5.375)]. HCV infection, older age, and liver cirrhosis significantly correlate with an increased risk of gallstone development in Chinese patients with CLD. HCV infection further increases this risk in both patients with liver cirrhosis and in elderly CLD patients (≥60 years of age).

Risk factors for gallstones and kidney stones in a cohort of patients with inflammatory bowel diseases.

BackgroundGallstones and kidney stones are known complications of inflammatory bowel diseases (IBD). Risk factors have been insufficiently studied and explanatory studies date back up to 30 years. It remains unclear, whether improved treatment options also influenced risk factors for these complications.ObjectivesIdentifying risk factors for gallstones and kidney stones in IBD patients.MethodsUsing data from the Swiss Inflammatory Bowel Disease Cohort Study we assessed associations of diseases characteristics with gallstones and kidney stones in univariate and multivariate logistic regression analyses.ResultsOut of 2323 IBD patients, 104 (7.8%) Crohn’s disease (CD) and 38 (3.8%) ulcerative colitis (UC) patients were diagnosed with gallstones. Significant risk factors for gallstones were diagnosis of CD, age at diagnosis, disease activity and duration, NSAID intake, extra-intestinal manifestations and intestinal surgery. Kidney stones were described in 61 (4.6%) CD and 30 (3.0%) UC patients. Male gender, disease activity, intestinal surgery, NSAID usage and reduced physical activity were significant risk factors. Hospitalization was associated with gallstones and kidney stones. The presence of gallstones increased the risk for kidney stones (OR 4.87, p<0.001).ConclusionThe diagnosis of CD, intestinal surgery, prolonged NSAID use, disease activity and duration and bowel stenosis were significantly associated with cholecystonephrolithiasis in IBD.

Prevalence and Risk Factors for Gallstones among Population in Riyadh City, KSA 2017

Background: The most common risk factors for gallstones formations are old age, female gender, obesity and diabetes mellitus. However, information about the prevalence and significant risk factors in Kingdom of Saudi Arabia (KSA) are limited. Objectives: Evaluating the prevalence and risk factors of gallstone disease among Saudi population in Riyadh, Kingdom of Saudi Arabia (KSA). Methods: A cross sectional study that included 500 subjects adult Saudi population who were randomly chosen from February –June 2017. The volunteers were subjected to clinical evaluation, laboratory investigations and ultrasound examination. Results: The overall prevalence of gallstone disease was 8.6%. The older age, female gender, physical activities and obesity are key factors in the gallstones progression. Also, diabetes, liver enzymes and the lipid profile were modifiable risk factors for gallstones. Conclusion: The risk factors for gallstones formation are old age, female gender, physical activities and obesity were key factors in the gallstones progression.

Gallstone prevalence and risk factors in patients with ulcerative colitis in Korean population.

This study aims to evaluate the prevalence, risk factors, and relative risk of gallstones and associated disease in patients with ulcerative colitis (UC). Medical records of 311 patients diagnosed with UC between January 2004 and February 2015 were reviewed retrospectively. To assess relative risk, 622 patients matched by age, sex, and body mass index were included as a control group. Gallstones were detected in 8% (25/311) of UC patients and in 3.9% (24/622) of the control group. Prevalence was significantly higher in the UC group (odds ratio [OR], 2.178; P = .007). Mean age of gallstone patients was 57.1 ± 17.8 years in the UC group, and mean disease duration of UC was 67.2 ± 38.8 months. The male-to-female ratio of gallstone patients in the UC group was 2.13:1. Mean interval from diagnosis of UC to detection of gallstones was 17.8 ± 30 months. Six UC patients with gallstones underwent cholecystectomy or endoscopic retrograde cholangiography for symptomatic disease and complications. In univariate analysis, diabetes, hypertension, age ≥65 years, and history of more than 3 admissions were significantly associated with gallstone in UC patients. In multivariate analysis, age ≥65 years (OR, 2.655; P = .033) and hospitalization ≥3 times (OR, 4.1; P = .001) were statistically significant risk factors for gallstones in UC patients. This study shows that UC patients have a significantly higher risk of gallstones compared to the general population (OR, 2.178; P = .007), especially those who are older, with a history of multiple admissions.

Liver cirrhosis

We investigated the possible link between liver cirrhosis and gallstone risk in chronic hepatitis C (CHC) patients in China.To analyze the association between liver cirrhosis and gallstone development, we compared outcomes of 133 Chinese CHC patients with gallstones and an age-, sex-, and hepatitis C virus RNA level-matched control group of 431 CHC patients without gallstones.We found that liver cirrhosis was more prevalent in gallstone patients (40.6%) than in the control group (24.4%). Logistic regression analyses adjusting for demographic features and other gallstone risk factors revealed that liver cirrhosis increased the risk of gallstone development 2-fold (adjusted odds ratio [AOR]: 2.122; 95% confidence interval [CI]: 1.408–3.198). Moreover, multivariate analyses comparing the risk of gallstone development in liver cirrhosis patients with decompensated or compensated liver cirrhosis yielded an estimated AOR (95% CI) of 2.869 (1.277–6.450) in patients with decompensated liver cirrhosis. Gallstone risk also increased significantly with older age (>60 years) (AOR: 2.019; 95% CI: 1.017–4.009).Liver cirrhosis significantly correlates with increased risk of gallstone development in CHC patients in China. Decompensated liver cirrhosis and older age further heighten this risk in patients diagnosed with hepatitis C-related cirrhosis.

Gallstones.

Gallstones grow inside the gallbladder or biliary tract. These stones can be asymptomatic or symptomatic; only gallstones with symptoms or complications are defined as gallstone disease. Based on their composition, gallstones are classified into cholesterol gallstones, which represent the predominant entity, and bilirubin ('pigment') stones. Black pigment stones can be caused by chronic haemolysis; brown pigment stones typically develop in obstructed and infected bile ducts. For treatment, localization of the gallstones in the biliary tract is more relevant than composition. Overall, up to 20% of adults develop gallstones and >20% of those develop symptoms or complications. Risk factors for gallstones are female sex, age, pregnancy, physical inactivity, obesity and overnutrition. Factors involved in metabolic syndrome increase the risk of developing gallstones and form the basis of primary prevention by lifestyle changes. Common mutations in the hepatic cholesterol transporter ABCG8 confer most of the genetic risk of developing gallstones, which accounts for ∼25% of the total risk. Diagnosis is mainly based on clinical symptoms, abdominal ultrasonography and liver biochemistry tests. Symptoms often precede the onset of the three common and potentially life-threatening complications of gallstones (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge on the genetics and pathophysiology of gallstones has expanded recently, current treatment algorithms remain predominantly invasive and are based on surgery. Hence, our future efforts should focus on novel preventive strategies to overcome the onset of gallstones in at-risk patients in particular, but also in the population in general.