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Multiple Risk Factors May Lead to Gallstones and Kidney Stones in Patients with IBD

November 6, 2017
New research proposes significant correlations between irritable bowel diseases such as Crohn’s and colitis, and the development of gallstones and kidney stones.

Inflammatory bowel disease, or IBD, consists of a group of inflammatory, autoimmune bowel diseases, such as Crohn’s disease (CD) and ulcerative colitis (UC), affecting the digestive tract. Symptoms may include abdominal pain, diarrhea, and rectal bleeding. While gallstones and kidney stones are known comorbidities of IBD, researchers further explored their inter-relationship by assessing risk factors for their development.

Risk Factors:  NSAIDs, Age, Physical Activity, and Gender 

In a study published in PLoS One,1 intestinal surgery, extended use of nonsteroidal anti-inflammatory drugs (NSAIDs), stenosis of the bowel, activity, and duration of disease, and diagnosis of Crohn’s disease may all be correlated with an increased risk of gallstones and kidney stones in patients with inflammatory bowel disease.

Using data from the Swiss Inflammatory Bowel Disease Cohort Study (Swiss IBD Cohort Study), an adult, population-based cohort in Canton of Vaud, Switzerland, the study included 2,323 patients with IBD. Of these, 55.4% reported having CD and 42.6% reported having ulcerative colitis.1

"Among the subjects, 7.8% of patients with CD and IBD, and 3.8% of patients with UC and IBD were diagnosed with gallstones.1 A multivariate analysis demonstrated that, in addition to a CD diagnosis, several other factors were correlated with the presence of gallstones in patients with IBD," according to the authors. These included:1

  • Extraintestinal manifestations of disease (OR 0.546; CI: 0.372-0.801, P= 0.002)
  • Age at diagnosis (per year; OR 1.023; CI: 1.009-1.036, P = 0.001)
  • Duration of disease (per year; OR 1.026; CI: 1.008-1.045, P = 0.005)
  • History of intestinal surgery (OR 2.623; CI: 1.734-3.968, P < 0.001)
  • NSAID usage (OR 1.715; CI: 1.087-2.708, P = 0.021)
  • Disease activity (OR 1.037; CI: 1.025-1.050, P < 0.001).

Within this same cohort, 4.6% of patients with CD and 3.0% of patients with UC was diagnosed with kidney stones, said lead author, Stefania Fagagnini, Division of Gastroenterology and Hepatology at the University Hospital in Zurich, Switzerland. A multivariate analysis showed five significant risk factors for the development of kidney stones in patients with IBD.These included:

  • Level of disease activity (OR 1.032; CI: 1.018-1.045, p < 0.001)
  • Prolonged use of NSAIDs (OR 2.334; CI: 1.415-3.851, p = 0.001)
  • Decreased physical activity (for weekly or daily activity: OR 0.434; CI: 0.242-0.780, P = 0.005)
  • Being male (for women: OR 0.533; CI: 0.341-0.833, P  = 0.006).

In addition, the presence of gallstones demonstrated a risk factor for the development of kidney stones (OR 4.87; CI: 2.8-8.0, p < 0.001).1

Kidney stonesKidney stones may be more prone to develop in patients with IBD.

Hospitalization was also correlated with increased risk of developing gallstones and kidney stones in the study cohort. Among participants who had been hospitalized during the previous 12 months, 35.1% had gallstones, compared to a prevalence of 4.1% among those without a hospitalization (OR 12.6; CI: 8.5-18.7, P < 0.001),1 according to the research team. This trend persisted among patients subdivided by diagnosis of CD (OR 9.80; P < 0.001), or of UC (OR 20.15; P < 0.001).

Prior hospitalization correlated with kidney stones at a rate of 26.5% compared to a prevalence of 2.5% among patients not previously hospitalized (OR 13.9; CI: 8.8-22.1, P < 0.001). This association was maintained among patients diagnosed with CD (OR 13.3; P < 0.001), or with UC (OR 14.4; P < 0.001).

Unique Mechanisms in IBD Patients Prompt Revised Guidelines

Although both gallstones and kidney stones may be associated with IBD, the study’s authors described different mechanisms that may influence their development. Without sufficient ileal activity, for example, they noted that a patient’s bile may contain excess bilirubin, which may form gallstones. Furthermore, a patient with IBD may experience multiple effects in the digestive tract that potentiate a risk of gallstones.

Kidney stones typically form due to a high abundance of oxalate or similar compounds in the urine, according to the study publication. IBD may result in more concentrated urine due to factors such as dehydration from diarrhea and dysregulation of absorption of salts in the ileum. An ileostomy may also result in urine that is more acidic.

Dr.Fagagnini and her co-authors  suggested that clinical trials further explore treatment and relationships between IBD and the development of gallstones and kidney stones. Specifically, they recommended studying the use of ursodeoxycholic acid in IBD patients at risk of gallstones; and a diet low in oxalate and high in fluid, with decreased ingestion of some fatty acids, for IBD patients at higher risk of kidney stones. 

The authors disclosed no competing financial interests.

Last updated on: November 6, 2017
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