Colectomy for ulcerative colitis tied to gallstone disease

Last Updated: 2017-02-09

By Rita Buckley

NEW YORK (Reuters Health) – The risk of gallstone disease is increased following colectomy for ulcerative colitis, researchers have found.

Dr. Anders Mark-Christenson from Aarhus University Hospital in Denmark and colleagues analyzed data on patients diagnosed with ulcerative colitis between 1977 and 2012 from the Danish National Patient Register.

The team matched 4,548 patients who had undergone colectomy by age and gender to more than 44,000 patients without colectomy.

During a median follow-up of nearly 12 years, 1,963 patients were hospitalized for gallstone disease, with colectomy patients being at significantly higher risk (adjusted hazard ratio, 1.63).

Sensitivity analyses of the risk of cholecystectomy showed a similar association (aHR, 1.55), the researchers report online January 24 in the American Journal of Gastroenterology.

An ileal pouch-anal anastomosis did not significantly affect the risk of developing gallstones among patients who had a colectomy.

“Clinicians should be aware of the health-related consequences of a colectomy,” the researchers write, adding that further research may clarify if preemptive cholecystectomy for selected patients in feasible and safe.

Dr. Adam Cheifetz, director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center in Boston, agreed physicians should be aware of the increased risk.

However, he told Reuters Health by email, “It is not clear that anything can be done to mitigate the risk, and prophylactic cholecystectomy is not warranted at this time.”

Dr. Edward V. Loftus, Jr., professor of medicine in the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, noted that most patients “will not get gallbladder disease even if they’ve had a colectomy.”

“The absolute risk is very low,” Dr. Loftus, who also was not involved in the study, told Reuters Health by phone.

Dr. Susan Hutfless, director of the Gastrointestinal Epidemiology Research Center at Johns Hopkins University in Baltimore, Maryland, said the study does not mention that the rate of gallstone disease in the ulcerative colitis population may be lower than in the general population.

“The 5-year risk in ulcerative colitis patients was 1.3%. In the general population, the lifetime risk is 10-20%,” she told Reuters Health by email.

“Advocating for concomitant cholecystectomy seems unwarranted given that the rate of gallstone disease does not appear to be higher in the population with colectomy than in the general population,” she said.

The corresponding author did not respond to requests for comments.

SOURCE: http://bit.ly/2kRzdZf

Am J Gastroenterol 2017.