Cirrhosis of liver is a risk factor for gallstone disease

Nikhil U. Shirole, Sudhir J. Gupta, Dharmesh K. Shah, Nitin R. Gaikwad, Tushar H. Sankalecha, Harit G. Kothari


Background: Gallstones are common clinical finding in general population. Mean prevalence rate in Indian population is 4-5%. The prevalence of gallstones is found to be high in cirrhotic patients compared to the general population in some western studies. Cause of this increased prevalence however is not known. Aim of the study was to evaluate prevalence of the gall stones in the cirrhotic patients, assess risk factors in cirrhotic patients and clinical presentation.

Methods: This is the cross sectional observational study, included cirrhotic patients (compensated or decompensated). Risk factors for gallstone formation (age, gender and diabetes mellitus), characteristics of liver cirrhosis (etiology, Child Turcotte Pugh class, hypersplenism and varices) and clinical presentation were assessed in all cirrhotic patients with gallstones.

Results: 336 patients with liver cirrhosis are included in this study; 201 (59.80%) male and 135 (40.2%) female. Mean age of the patients is 44.95±13.1 years. Overall prevalence of gall stones was 12.8% (43/336). Out of 43 patients, 23 (53.5%) are male and 20 (46.5%) are female. As child status progresses from A to B to C, prevalence of gall stone increases, with 60.46% (26/43) of gall stones occurring in the patients with CTP class C. Only 8 (18.6%) patients had gallstone related symptoms while rests were asymptomatic. 5 (11.6%) had concurrent CBD stones. Cholecystectomy was possible in only 2 patients with symptomatic gallstones.

Conclusions: The prevalence of gall stones in cirrhotic is higher than general population which increases with the severity of liver cirrhosis. Most cirrhotic patients are asymptomatic for gallstones.


Cirrhosis, Cholelithiasis, Gallstone disease

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Kratzer W, Mason RA, Kachele V. Prevalence of gallstones in sonographic surveys worldwide. Journal of clinical ultrasound. JCU. 1999;27(1):1-7.

Unisa S, Jagannath P, Dhir V, Khandelwal C, Sarangi L, Roy TK. Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural Gangetic basin of North India. HPB. Official J Inter Hepato Pancreato Biliary Association. 2011;13(2):117-25.

Attili AF, Carulli N, Roda E, Barbara B, Capocaccia L, Menotti A, et al. Epidemiology of gallstone disease in Italy: prevalence data of the Multicenter Italian Study on Cholelithiasis (M.I.COL.). Amer J epidem. 1995;141(2):158-65.

Heaton KW, Braddon FE, Mountford RA, Hughes AO, Emmett PM. Symptomatic and silent gall stones in the community. Gut. 1991;32(3):316-20.

Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. Journal of clinical epidemiology. 1989;42(2):127-36.

Fornari F, Civardi G, Buscarini E, Cavanna L, Imberti D, Rossi S, et al. Cirrhosis of the liver. A risk factor for development of cholelithiasis in males. Dig Dis Sci. 1990;35(11):1403-8.

Acalovschi M. Gallstones in patients with liver cirrhosis: incidence, etiology, clinical and therapeutical aspects. WJG. 2014;20(23):7277.

Acalovschi M, Dumitrascu DL, Nicoara CD. Gallbladder Contractility in Liver Cirrhosis: Comparative Study in Patients with and Without Gallbladder Stones. Dig Dis Sci. 2004;49(1):17-24.

Chawla A, Puthumana L, Thuluvath PJ. Autonomic Dysfunction and Cholelithiasis in Patients with Cirrhosis. Dig Dis Sci. 2001;46(3):495-8.

Goebell H, Rudolph HD, Breuer N, Hartmann W, Leder HD. [The frequency of gallstones in liver cirrhosis (author's transl)]. Zeitschrift fur Gastroenterologie. 1981;19(7):345-55.

Conte D, Fraquelli M, Fornari F, Lodi L, Bodini P, Buscarini L. Close relation between cirrhosis and gallstones: cross-sectional and longitudinal survey. Archives of internal medicine. 1999;159(1):49-52.

Grassi M, Allevato C, Mammucari S, Lazzari S, Nocchi S. The prevalence of gallstones in patients suffering from liver cirrhosis: a clinico-statistical study of 350 patients. Ital J Gastroenterol. 1992;24(6):342-6.

Acalovschi M, Dumitrascu D, Ban A, Petrescu A. A necroptic study of the prevalence of cholelithiasis in liver cirrhosis. Med Interne. 1986;24(1):23-7.