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Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case-control study.
Am J Gastroenterol 2003; 98(8):1856-60AJ

Abstract

OBJECTIVES

Liver cirrhosis is a well-documented risk factor for the formation of gallstones. In cirrhotic patients, gallstones are almost always "silent," and surgery is rarely required. When indicated (symptoms or complications), cholecystectomy implies a high morbidity risk in these patients, especially in the advanced stages of cirrhosis. The aim of this study was to estimate the risk factors for symptom development in cirrhotic patients with gallstones to identify the subgroup of patients at risk of undergoing surgery.

METHODS

A total of 140 patients with liver cirrhosis and gallstones were studied: 97 with asymptomatic and 43 with symptomatic gallstone disease. The risk factors for gallstone formation (age, gender, family history, parity, obesity, diabetes mellitus, hyperlipoproteinemia) and the characteristics of liver cirrhosis (etiology, duration, Child class, hypersplenism), gallstones (duration, number, size), and gallbladder (size, wall thickness) were assessed in all patients. In 12 patients (four symptomatic, eight asymptomatic), gallbladder emptying was also evaluated by ultrasound. The association of asymptomatic and symptomatic gallstones with all these parameters was statistically evaluated by Student's t, Mann-Whitney, and chi(2) tests, as well as by means of multiple logistic regression. The causal relationship between these characteristics and gallstone symptoms was also examined by means of the KDD (knowledge discovery from databases) method, with an algorithm for learning Bayesian networks.

RESULTS

Advanced age, female gender, viral etiology of cirrhosis, family history of gallstones, and duration of gallstone disease were significantly associated with symptomatic gallstone disease. The number or size of gallstones and the size or emptying of the gallbladder did not differ in symptomatic versus asymptomatic patients. Male gender and alcoholic cirrhosis were inversely correlated with symptom presence. In the multivariate analysis, family history (p = 0.0098) and advanced age (p = 0.0422) were positively correlated and male gender (p = 0.0049) and alcoholic etiology of cirrhosis (p = 0.0116) negatively correlated with symptom presence. These relationships (except for age) were also evidenced by the KDD method.

CONCLUSIONS

The risk of gallstones becoming symptomatic is significantly lower in men and in alcoholic cirrhosis. In cirrhotic women, and especially in the presence of a positive family history and of advanced age, the risk of developing symptoms and undergoing surgery was significantly greater.

Authors+Show Affiliations

Third Medical Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12907344

Citation

Acalovschi, Monica, et al. "Risk Factors for Symptomatic Gallstones in Patients With Liver Cirrhosis: a Case-control Study." The American Journal of Gastroenterology, vol. 98, no. 8, 2003, pp. 1856-60.
Acalovschi M, Blendea D, Feier C, et al. Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case-control study. Am J Gastroenterol. 2003;98(8):1856-60.
Acalovschi, M., Blendea, D., Feier, C., Letia, A. I., Ratiu, N., Dumitrascu, D. L., & Veres, A. (2003). Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case-control study. The American Journal of Gastroenterology, 98(8), pp. 1856-60.
Acalovschi M, et al. Risk Factors for Symptomatic Gallstones in Patients With Liver Cirrhosis: a Case-control Study. Am J Gastroenterol. 2003;98(8):1856-60. PubMed PMID: 12907344.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case-control study. AU - Acalovschi,Monica, AU - Blendea,Dan, AU - Feier,Cristina, AU - Letia,Alfred I, AU - Ratiu,Nadia, AU - Dumitrascu,Dan L, AU - Veres,Adina, PY - 2003/8/9/pubmed PY - 2003/9/30/medline PY - 2003/8/9/entrez SP - 1856 EP - 60 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 98 IS - 8 N2 - OBJECTIVES: Liver cirrhosis is a well-documented risk factor for the formation of gallstones. In cirrhotic patients, gallstones are almost always "silent," and surgery is rarely required. When indicated (symptoms or complications), cholecystectomy implies a high morbidity risk in these patients, especially in the advanced stages of cirrhosis. The aim of this study was to estimate the risk factors for symptom development in cirrhotic patients with gallstones to identify the subgroup of patients at risk of undergoing surgery. METHODS: A total of 140 patients with liver cirrhosis and gallstones were studied: 97 with asymptomatic and 43 with symptomatic gallstone disease. The risk factors for gallstone formation (age, gender, family history, parity, obesity, diabetes mellitus, hyperlipoproteinemia) and the characteristics of liver cirrhosis (etiology, duration, Child class, hypersplenism), gallstones (duration, number, size), and gallbladder (size, wall thickness) were assessed in all patients. In 12 patients (four symptomatic, eight asymptomatic), gallbladder emptying was also evaluated by ultrasound. The association of asymptomatic and symptomatic gallstones with all these parameters was statistically evaluated by Student's t, Mann-Whitney, and chi(2) tests, as well as by means of multiple logistic regression. The causal relationship between these characteristics and gallstone symptoms was also examined by means of the KDD (knowledge discovery from databases) method, with an algorithm for learning Bayesian networks. RESULTS: Advanced age, female gender, viral etiology of cirrhosis, family history of gallstones, and duration of gallstone disease were significantly associated with symptomatic gallstone disease. The number or size of gallstones and the size or emptying of the gallbladder did not differ in symptomatic versus asymptomatic patients. Male gender and alcoholic cirrhosis were inversely correlated with symptom presence. In the multivariate analysis, family history (p = 0.0098) and advanced age (p = 0.0422) were positively correlated and male gender (p = 0.0049) and alcoholic etiology of cirrhosis (p = 0.0116) negatively correlated with symptom presence. These relationships (except for age) were also evidenced by the KDD method. CONCLUSIONS: The risk of gallstones becoming symptomatic is significantly lower in men and in alcoholic cirrhosis. In cirrhotic women, and especially in the presence of a positive family history and of advanced age, the risk of developing symptoms and undergoing surgery was significantly greater. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/12907344/Risk_factors_for_symptomatic_gallstones_in_patients_with_liver_cirrhosis:_a_case_control_study_ L2 - http://Insights.ovid.com/pubmed?pmid=12907344 DB - PRIME DP - Unbound Medicine ER -