Abstract
Cholelithiasis is considered an extraintestinal manifestation of Crohn's ileitis but has not been associated with ulcerative colitis. To evaluate if an increased risk of cholelithiasis exists in patients with ulcerative colitis, biliary ultrasonography was performed on 159 patients with inflammatory bowel disease, 114 patients with ulcerative colitis, and 45 patients with Crohn's disease. A control population of 2453 residents of the town near the authors' institute was also studied. An echographic survey of gallstones was performed on the control subjects, who participated in the Multicentrica Italiana Colelitiasi (MICOL). Seventeen patients with inflammatory bowel disease had gallstones (10.7 percent), 11 patients with ulcerative colitis had gallstones (9.6 percent), and 6 patients with Crohn's disease had gallstones (13.3 percent). In the control population, diagnosis of cholelithiasis was made in 239 subjects (9.7 percent). An estimate of the relative risk (odds ratio) of gallstones in ulcerative colitis and Crohn's disease and also in 4 subgroups formed on the basis of the extent of disease (total ulcerative colitis, partial ulcerative colitis, Crohn's disease with ileitis, Crohn's disease without ileitis) with respect to the general population was calculated using logistic regression with gallstones, sex, age, and body mass index as independent variables and inflammatory bowel disease as a dependent variable. The authors' findings show an increased risk of gallstones in both patients with Crohn's disease (odds ratio = 3.6; 95 percent confidence limits = 1.2–10.4;P = 0.02) and patients with ulcerative colitis (odds ratio = 2.5; 95 percent confidence limits = 1.2–5.2;P = 0.01). The risk was highest in patients with Crohn's disease involving the distal ileum (odds ratio = 4.5; 95 percent confidence limits = 1.5–14.1;P = 0.009) and in patients with total ulcerative colitis extending to the cecum (odds ratio = 3.3; 95 percent confidence limits = 1.3–8.6;P = 0.01). These results confirm that there is an increased risk of gallstones in Crohn's ileitis but they show that there also exists an increased risk in patients with total ulcerative colitis.
Similar content being viewed by others
References
Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn's disease and Ulcerative colitis: a study of 700 patients. Medicine 1976;55:401–12.
Christophi C, Hughes ER. Hepatobiliary disorders in inflammatory bowel disease. Surg Gynecol Obstet 1985;160:187–93.
Mir-Madjlessi SH, Farmer RG, Sivak MV Jr. Bile duct carcinoma in patients with ulcerative colitis. Relationship to sclerosing cholangitis: report of six cases and review of the literature. Dig Dis Sci 1987;32:145–54.
Scholmerich J, Braun G, Volk BA, Spamer C, Hoppe-Seyler P, Gerok W. Detection of extraintestinal and intestinal abnormalities in inflammatory bowel disease by ultrasound. Dig Surg 1987;4:82–7.
Baker AL, Kaplan MM, Norton RA, Patterson JF. Gallstones in inflammatory bowel disease. Am J Dig Dis 1974;19:109–12.
Whorwell PJ, Hawkins R, Dewbury K, Wright R. Ultrasound survey of gallstones and other hepatobiliary disorders in patients with Crohn's disease. Dig Dis Sci 1985;29:930–3.
Schachter H, Kirsner JB. Definitions of inflammatory bowel disease of unknown etiology. Gastroenterology 1975;68:591–600.
Andersson H, Bosaeus I, Fasth S, Hellberg R, Hulten L. Cholelithiasis and urolithiasis in Crohn's disease. Scand J Gastroenterol 1987;22:253–6.
Cohen S, Kaplan M, Gottlieb L, Patterson JF. Liver disease and gallstones in regional enteritis. Gastroenterology 1971;60:237–45.
Hill GL, Mair WSJ, Goligher JC. Gallstones after ileostomy and ileal resection. Gut 1975;16:932–6.
Marks JW, Conley DR, Capretta TL, et al. Gallstone prevalence and biliary lipid composition in inflammatory bowel disease. Am J Dig Dis 1977;22:1097–1100.
Heaton KW, Austad WI, Lack I, Tyor MP. Enterohepatic circulation of C14-labelled bile salts in disorders of the distal small bowel. Gastroenterology 1968;55:5–16.
Morris JS, Heaton KW. The fate of labelled bile salts introduced into the colon. Scand J Gastroenterol 1974;9:33–9.
Mekhjian HS, Sidney FP, Alan FH. Colonic absorption of unconjugated bile acids: perfusion studies in man. Dig Dis Sci 1979;24:545–50.
Fromm H, Thomas PJ, Hofmann AF. Sensitivity and specificity in tests of distal ileal function: prospective comparison of bile acid and vitamin B12 absorption in ileal resection patients. Gastroenterology 1973;64:1077–90.
Kruis W, Kalek D, Stellaard F, Paumgartner G. Altered fecal bile acid pattern in patients with inflammatory bowel disease. Digestion 1986;35:189–98.
Holmquist L, Anderson H, Rudic N, Ahréen C, Fallstrom SP. Bile acid malabsorption in children and adolescents with chronic colitis. Scand J Gastroenterol 1986;21:87–92.
Author information
Authors and Affiliations
About this article
Cite this article
Lorusso, D., Leo, S., Mossa, A. et al. Cholelithiasis in inflammatory bowel disease. Dis Colon Rectum 33, 791–794 (1990). https://doi.org/10.1007/BF02052328
Issue Date:
DOI: https://doi.org/10.1007/BF02052328