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 19 February 2018

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Increased risk of gallstone disease after colectomy for ulcerative colitis

The latest issue of the American Journal of Gastroenterology evaluated the risk of gallstone disease following colectomy and ileal pouch-anal anastomosis.

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Biochemical studies suggest that patients who have had a colectomy or restorative proctocolectomy with ileal pouch-anal anastomosis are at an increased risk of developing gallstone disease, but epidemiological studies are lacking. 

Dr Anders Mark-Christensen and colleagues from Denmark evaluated the risk of gallstone disease following colectomy and ileal pouch-anal anastomosis.

Individuals who had a colectomy were identified from a national cohort of patients with ulcerative colitis (UC), and controls without colectomy were sampled from within the same cohort, matching on gender, calendar year, and year of birth. 

1963 patients were hospitalized for gallstone disease
American Journal of Gastroenterology
The team used Cox regression to examine the effect of colectomy on the hazard rates of gallstone disease and cholecystectomy, adjusting for alcoholism, stroke, chronic obstructive pulmonary disease, cancer, cardiac disease, diabetes mellitus, hypothyroidism, hyperlipidemia, cirrhosis, obesity, renal failure, and transient ischemic attacks. 

The researchers determined the effect of an ileal pouch-anal anastomosis for patients who had colectomy by including the procedure as a time-dependent variable.

The research team identified 4548 patients, and matched these to 44,372 controls without colectomy. 

During a median follow-up of 12 years, 1963 patients were hospitalized for gallstone disease. 

The research team found that patients who had a colectomy were at an increased risk, and sensitivity analyses of the risk of undergoing cholecystectomy revealed a similar association. 

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

Dr Mark-Christensen's team concludes, "The risk of gallstone disease increases following colectomy for UC."

Am J Gastroenterol 2017; 112:473–478
13 March 2017

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