Prevalencia a rizikové faktory cholelitiázy u pacientov s Crohnovou chorobou

Autori: Šturdík I., Krajčovičová A., Lešková Z., Decká R., Černotová V., Koller T., Huorka M., Hlavatý T.

Pracovisko: V. interná klinika Lekárskej fakulty Univerzity Komenského a Univerzitnej nemocnice Bratislava


Background In thus far published literature, the cholelithiasis in patients with Crohn disease (CD) is twice more frequent than in the general population, the reported prevalence ranges from 13% to 34%. The reason for this difference has not been satisfactorily explained.

Aim The aim of our study was to assess  the prevalence of cholelithiasis in patients with CD and analyze the risk factors of gallstone formation.

Materials and methods We retrospectively evaluated all CD patients who underwent an abdominal ultrasound performed by one sonographer at a single tertiary IBD center between years 2007 and 2015. Medical records were reviewed and patients demographics, behavior, localisation, duration and number of flare of CD, number and type of bowel resections, number and length of total hospitalization, number of total parenteral nutrition treatment and presence of cholelithiasis and its characterization were noted. An univariate and a multivariate analysis were performed using logistic regression analysis (with cholelithiasis as the dependent variable). Prevalence and odds ratios were calculated with their 95% confidence intervals.

Results In total, 111 CD patients (median age 38 [21 to 77 years]; 53% of males) were evaluated. We observed 13 cases (12%) of cholelithiasis confirmed by ultrasound, 11 cases of cholecystolithiasis and 2 cases of choledocholithiasis. The majority of patients with cholelithiasis remained asymptomatic during follow-up mean 141 months, only 5 (4,5%) cases had biliary symptoms. The prevalence of cholelithiasis was more common in fistulizing CD compared with the inflammatory behavior of CD, 20% vs 4,9%. The median age of CD patients with cholelithiasis was higher compared to patients without cholelithiasis, 53 vs 38 years, respectively. We observed no association between cholelithiasis and CD localisation, duration and number of flares, neither with number and type of bowel resections, number of hospitalizations and parenteral nutritions episodes.

Conclusion Cholelithiasis is a frequent complication of CD. In our cohort, the prevalence of cholelithiasis in CD patients was 12%. In multivariate analysis only fistulizing CD and median age were the only significant risk factors of cholelithiasis.