Cholelithiasis, Cholecystectomy, and Liver Disease

OBJECTIVES: 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.