Hepatitis Central

Arch Intern Med. 1999;159:49-52

"Close Relation Between Cirrhosis and Gallstones:
Cross-sectional and Longitudinal Survey"

Dario Conte, MD; Mirella Fraquelli, MD; Fabio Fornari, MD; Lucia Lodi, MD; Paolo Bodini, MD; Luigi Buscarini, MD

Background:

Increased gallstone prevalence and incidence in cirrhosis have already been reported in different series, including a limited number of patients with cirrhosis.

Objective:

To evaluate the frequency of gallstones and related risk factors in a large series of patients with cirrhosis.

Patients and Methods:

The cross-sectional study involved 1010 patients with cirrhosis related to alcohol abuse, chronic viral infection, or miscellaneous causes (42%, 48%, and 10%, respectively) in Child class A, B, or C (48%, 36%, and 16%, respectively). In the longitudinal study gallstone development was monitored ultrasonographically in 618 patients free of gallstones at enrollment.

Results:

The overall prevalence of gallstone(s) was 29.5% and increased significantly with age without differences according to sex or cause of cirrhosis. Multiple logistic regression analysis showed that only Child classes B and C were significantly related to a higher risk of gallstone (odds ratio, 1.63 for class C vs class A and 1.91 for class B vs class A; P=.001). During a mean ± SD follow-up of 50 months ± 9 months, 141 (22.8%) of 618 patients developed gallstone(s), with an estimated cumulative probability of 6.5%, 18.6%, 28.2%, and 40.9% at 2, 4, 6, and 8 years, respectively. Multivariate analysis showed that Child class (hazard ratio, 2.8 for class C vs class A and 1.8 for class B vs class A; P=.002 and P=.001, respectively) and high-body mass index (hazard ratio, 1.31; P=.04) carried a significantly greater risk of gallstone formation.

Conclusion:

Cirrhosis per se represents a major risk factor for gallstones whose prevalence and incidence were far higher than those reported in a general population from the same area.