Patients with ulcerative colitis may have an increased risk for gallstone disease after undergoing colectomy, according to the results of a Danish national cohort study.
This finding led researchers to call for further studies to identify high-risk patients to minimize the negative effects of gallstones after colectomy.
“For years, we have known that a colectomy induces changes to the composition of bile, but it has been unclear whether these changes are reflected in a greater risk of gallstone disease,” Anders Mark-Christensen, MD, of the department of surgery, section of coloproctology, Aarhus University Hospital, Denmark, told Healio Gastroenterology. “We found that individuals with ulcerative colitis who had a colectomy had a 63% higher risk of being hospitalized for gallstone disease compared to those with ulcerative colitis without colectomy.”
To evaluate the associations between the risk for gallstone disease after colectomy and ileal pouch-anal anastomosis (IPAA), Mark-Christensen and colleagues used a Danish national registry to identify 4,548 UC patients who had a colectomy and 44,372 matched controls with UC who did not have a colectomy. Over a median follow-up of 11.9 years, 1,963 patients were hospitalized for gallstone disease.
After adjusting for a variety of confounders, they found that patients who had undergone colectomy had a higher risk for gallstone disease compared with those who had not (adjusted HR = 1.63; 95% CI, 1.39-1.91).
“The risk of undergoing cholecystectomy was equally increased following colectomy, and this suggests that the gallstones are not coincidental findings but rather that they cause problems,” Mark-Christensen said.
Sensitivity analyses showed the adjusted HR for cholecystectomy after colectomy was 1.55 (95% CI, 1.22-1.98).
In addition, a concurrent or subsequent IPAA had no effect on the risk for developing gallstones among the patients who had undergone colectomy (aHR = 1.03; 95% CI, 0.77-1.37).
“It is, however, still unclear if gallstone disease in these individuals is more difficult to treat than in patients without colectomy and UC, where it is typically a condition with an optimistic prognosis,” Mark-Christensen said.
He and his colleagues concluded that the burden of gallstone disease and its complications in this patient population may be reduced by identifying those who may benefit from preventive measures, such as a prophylactic cholecystectomy. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.