Cholelithiasis, cholecystectomy, and liver disease.
OBJECTIVE
Cholelithiasis and fatty liver disease share some important risk factors, such as central obesity, insulin resistance, and diabetes. We sought to determine whether persons with cholelithiasis or a history of cholecystectomy were more likely to have elevated serum liver enzymes or to develop cirrhosis.


METHODS
We used cohort data from the first National Health and Nutrition Examination Survey (NHANES), to determine whether persons with a self-reported history of cholecystectomy at baseline (n=466) had a higher incidence of hospitalization or death due to cirrhosis than persons without a history of cholecystectomy (n=8,691) during up to 21 years of follow-up. We also used cross-sectional data from the third NHANES conducted between the years 1988 and 1994 to determine whether persons with cholelithiasis (n=833) or previous cholecystectomy (n=709), as determined by ultrasonography, were more likely to have elevated serum alanine aminotransferase (ALT) or gamma-glutamyl transferase (GGT) than persons without cholecystectomy or cholelithiasis (n=8,027).


RESULTS
Persons with previous cholecystectomy were two times more likely to be hospitalized for or die of cirrhosis (adjusted hazard ratio 2.1, 95% confidence interval (CI) 1.1-4.0) and were more likely to have elevated serum ALT (adjusted odds ratio 1.8, 95% CI 1.3-2.5) or GGT (adjusted odds ratio 1.7, 95% CI 1.1-2.6) than persons without cholecystectomy. We did not identify an independent association between cholelithiasis and serum ALT or GGT levels.


CONCLUSIONS
Cholecystectomy is a predictor of the development cirrhosis and is associated with elevated serum liver enzymes. Cholelithiasis is not independently associated with serum liver enzyme levels; whether cholelithiasis is associated with the development of cirrhosis remains to be determined.
Ioannou
George N
GN
Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington 98108, USA. georgei@medicine.washington.edu
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D002763:Cholecystectomy / Q000009:adverse effects; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011446:Prospective Studies; D014481:United States; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase