Gallstones associated with nonalcoholic steatohepatitis (NASH) and metabolic syndrome.

Department of Surgery, Göztepe Training and Research Hospital, İstanbul.
The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology (Impact Factor: 0.47). 12/2010; 21(4):411-5.
Source: PubMed

ABSTRACT We aimed to evaluate the prevalence of non-alcoholic steatohepatitis and metabolic syndrome in patients with symptomatic gallstones undergoing laparoscopic or open cholecystectomy.
A study of 95 patients was performed. Simultaneous liver biopsies were taken during cholecystectomy between 2006 and 2007. There were no postoperative complications. Patients with significant alcohol intake, hepatitis B or C (virus-positive), autoimmune diseases, and Wilson's disease were excluded. Demographics, liver function tests, lipid profile, and ultrasound findings of patients with and without non-alcoholic steatohepatitis were compared.
A total of 95 patients completed the study. The mean age was 52.15 years, and 29 patients were male and 66 female. Fifty-two patients (55%) had biopsies compatible with non-alcoholic steatohepatitis.
Fifty-five percent of patients with gallbladder stones had associated non-alcoholic steatohepatitis. Awareness of this association may result in an earlier diagnosis. The high prevalence of non-alcoholic steatohepatitis in patients with gallbladder stone may justify routine liver biopsy during cholecystectomy to establish the diagnosis and stage and possibly direct therapy.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are both highly prevalent in the general population and are associated with obesity, insulin resistance, dyslipidemia, and high dietary cholesterol intake. Insulin resistance is a key feature of both NAFLD and GD. Hepatic insulin resistance provides a crucial link between the metabolic syndrome, NAFLD, and increased cholesterol gallstone susceptibility. Hepatic insulin resistance is not only associated with accumulation of hepatic fat but also has a crucial role in supersaturation and excessive production of bile salts. It is not yet clear whether NAFLD is a precursor of GD or whether the presence of GD possibly indicates the presence of long-standing features of metabolic syndrome that accelerates the progression of NAFLD. Recent reports suggested the association between gallstones and nonalcoholic steatohepatitis and liver fibrosis. Importantly, both NAFLD and GD are both associated with high incidence of cardiovascular disease (CVD) and mortality. Emerging evidence suggests a potential benefit of statin therapy in NAFLD and GD. Further research is needed to determine (i) how the presence of NAFLD and GD is associated with CVD (ii) and whether the presence of GD in association with NAFLD increases the risk of liver fibrosis, and (iii) the impact of therapy of NAFLD in the incidence of GD.
    Scandinavian Journal of Gastroenterology 03/2014; · 2.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We sought to examine whether the presence of gallstone disease (GD) in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) is associated with liver fibrosis and histological nonalcoholic steatohepatitis (NASH) score. We included 441 Turkish patients with biopsy-proven NAFLD. GD was diagnosed in the presence of sonographic evidence of gallstones, echogenic material within the gallbladder with constant shadowing and little or no visualization of the gallbladder or absence of gallbladder at ultrasonography, coupled with a history of cholecystectomy. Fifty-four patients (12.2%) had GD (GD+ subjects). Compared with the GD- subjects, GD+ patients were older, had a higher body mass index and were more likely to be female and have metabolic syndrome. However, GD+ patients did not have a higher risk of advanced fibrosis or definite NASH on histology. After adjustment for potential confounding variables, the prevalence of GD in NAFLD patients was not associated with significant fibrosis (≥2) (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.53 to 2.21; p=0.68) or definite NASH (OR, 1.03; 95% CI, 0.495 to 2.12; p=0.84). The presence of GD is not independently associated with advanced fibrosis and definite NASH in adult Turkish patients with biopsy-proven NAFLD.
    Gut and Liver 05/2014; 8(3):313-7.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about risk factors for biliary pancreatitis in children. We characterized cases of pediatric biliary pancreatitis, compared biliary with nonbiliary cases, examined differences in presentation between younger and older children, and studied features distinguishing gallstone- from sludge-induced pancreatitis. We evaluated 76 episodes of biliary pancreatitis from 271 cases of acute pancreatitis in children admitted to a tertiary care hospital from 1994 to 2007. Of the 76 cases, 55% had gallstones, 21% had sludge, and 24% had structural defects. Hispanic children had 2.85 (P = 0.01) and 5.59 (P = 0.003) times higher probability for biliary pancreatitis than white and black children, respectively. Median serum amylase and lipase in children with biliary pancreatitis were 64% and 49% higher, respectively, compared with other causes (P < 0.05). In multiple logistic regression, aspartate aminotransferase was an independent predictor of biliary pancreatitis (odds ratio 6.69, P = 0.001). When comparing gallstone- with sludge-induced causes, obesity was an independent predictor (38% more prevalent, P < 0.01) of gallstone cases. Hispanic ethnicity is a risk factor and aspartate aminotransferase is a biomarker for biliary pancreatitis over other causes. Furthermore, obesity can distinguish gallstone- from sludge-induced pancreatitis. These findings may spur prospective studies to determine the optimal evaluation and management of children with biliary pancreatitis.
    Journal of pediatric gastroenterology and nutrition 10/2011; 54(5):651-6. · 2.18 Impact Factor