The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Prevalence and risk factors for gallstone and renal stone formation in patients with intestinal Behçet's disease

  • Jaewon Song (Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine) ;
  • Soo Jung Park (Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine) ;
  • Jae Jun Park (Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine) ;
  • Tae Il Kim (Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine) ;
  • Jihye Park (Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine) ;
  • Jae Hee Cheon (Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2024.01.10
  • Accepted : 2024.04.08
  • Published : 2024.09.01
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Abstract

Background/Aims: The association between inflammatory bowel disease (IBD) and gallstone and renal stone formation has been established. However, few studies have investigated this association in patients with intestinal Behçet's disease (BD). We aimed to examine the prevalence of gallstones and renal stones in patients with intestinal BD and identify potential risk factors. Methods: We analyzed gallstone and renal stone occurrences in 553 patients diagnosed with intestinal BD who had undergone cross-sectional imaging examinations between March 2005 and April 2021 at the IBD Center, Severance Hospital, Seoul, South Korea. Logistic regression models were used to identify risk factors for gallstone and renal stone formation. Results: Of 553 patients over a mean 12.1-year duration, 141 (25.4%) patients had gallstones and 35 (6.3%) had renal stones. In multivariate logistic regression analysis, disease duration > 19 years (OR 2.91, 95% CI 1.56-5.44, p < 0.001), prior intestinal BD-related surgery (OR 2.29, 95% CI 1.42-3.68, p < 0.001), and disease activity index for intestinal BD scores ≥ 75 (OR 2.23, 95% CI 1.12-4.45, p = 0.022) were associated with increased gallstone occurrence. A positive correlation was observed between renal stones, disease duration > 19 years (OR 5.61, 95% CI 1.98-15.90, p = 0.001) and frequent hospitalization (> 3 times) (OR 3.29, 95% CI 1.52-7.13, p = 0.002). No significant correlation was observed between gallstone and renal stone occurrence. Conclusions: These findings contribute to greater understanding concerning gallstone and renal stone prevalence and associated risk factors in patients with intestinal BD.

Keywords

Acknowledgement

Authors are grateful to the patients and colleagues for their valuable contributions to this study.

References

  1. Sakane T, Takeno M, Suzuki N, Inaba G. Behcet's disease. N Engl J Med 1999;341:1284-1291.
  2. Kaklamani VG, Kaklamanis PG. Treatment of Behcet's disease--an update. Semin Arthritis Rheum 2001;30:299-312.
  3. Kim DH, Cheon JH. Intestinal Behcet's disease: a true inflammatory bowel disease or merely an intestinal complication of systemic vasculitis? Yonsei Med J 2016;57:22-32.
  4. Suzuki Y, Hagiwara T, Kobayashi M, Morita K, Shimamoto T, Hibi T. Long-term safety and effectiveness of adalimumab in 462 patients with intestinal Behcet's disease: results from a large real-world observational study. Intest Res 2021;19:301-312.
  5. Song EM, Yang SK. Natural history of inflammatory bowel disease: a comparison between the East and the West. Intest Res 2022;20:418-430.
  6. Grigg EL, Kane S, Katz S. Mimicry and deception in inflammatory bowel disease and intestinal behcet disease. Gastroenterol Hepatol (N Y) 2012;8:103-112.
  7. Cheon JH. Advances in management of intestinal Behcet's disease: a perspective from gastroenterologists. J Rheum Dis 2021;28:4-16.
  8. Koh SJ, Hong SN, Park SK, et al. Korean clinical practice guidelines on biologics for moderate to severe Crohn's disease. Intest Res 2023;21:43-60.
  9. Na SY, Choi CH, Song EM, et al. Korean clinical practice guidelines on biologics and small molecules for moderate-to-severe ulcerative colitis. Intest Res 2023;21:61-87.
  10. Banner MP. Genitourinary complications of inflammatory bowel disease. Radiol Clin North Am 1987;25:199-209.
  11. Dincer MT, Dincer ZT, Bakkaloglu OK, et al. Renal manifestations in inflammatory bowel disease: a cohort study during the biologic era. Med Sci Monit 2022;28:e936497.
  12. Fagagnini S, Heinrich H, Rossel JB, et al. Risk factors for gallstones and kidney stones in a cohort of patients with inflammatory bowel diseases. PLoS One 2017;12:e0185193.
  13. Lammert F, Gurusamy K, Ko CW, et al. Gallstones. Nat Rev Dis Primers 2016;2:16024.
  14. Heaton KW. Disturbances of bile acid metabolism in intestinal disease. Clin Gastroenterol 1977;6:69-89.
  15. Dowling RH, Bell GD, White J. Lithogenic bile in patients with ileal dysfunction. Gut 1972;13:415-420.
  16. Brink MA, Slors JF, Keulemans YC, et al. Enterohepatic cycling of bilirubin: a putative mechanism for pigment gallstone formation in ileal Crohn's disease. Gastroenterology 1999;116:1420-1427.
  17. Damiao AO, Sipahi AM, Vezozzo DP, Goncalves PL, Fukui P, Laudanna AA. Gallbladder hypokinesia in Crohn's disease. Digestion 1997;58:458-463.
  18. Mayans L. Nephrolithiasis. Prim Care 2019;46:203-212.
  19. McConnell N, Campbell S, Gillanders I, Rolton H, Danesh B. Risk factors for developing renal stones in inflammatory bowel disease. BJU Int 2002;89:835-841.
  20. Coe FL, Parks JH, Asplin JR. The pathogenesis and treatment of kidney stones. N Engl J Med 1992;327:1141-1152.
  21. Cheon JH, Kim ES, Shin SJ, et al. Development and validation of novel diagnostic criteria for intestinal Behcet's disease in Korean patients with ileocolonic ulcers. Am J Gastroenterol 2009;104:2492-2499.
  22. Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am 2010;39:157-169, vii.
  23. Chang YR, Jang JY, Kwon W, et al. Changes in demographic features of gallstone disease: 30 years of surgically treated patients. Gut Liver 2013;7:719-724.
  24. Sohgaura A, Bigoniya P. A review on epidemiology and etiology of renal stone. Am J Discov Dev 2017;7:54-62.
  25. Parente F, Pastore L, Bargiggia S, et al. Incidence and risk factors for gallstones in patients with inflammatory bowel disease: a large case-control study. Hepatology 2007;45:1267-1274.
  26. Fraquelli M, Losco A, Visentin S, et al. Gallstone disease and related risk factors in patients with Crohn disease: analysis of 330 consecutive cases. Arch Intern Med 2001;161:2201-2204.
  27. Zhang FM, Xu CF, Shan GD, Chen HT, Xu GQ. Is gallstone disease associated with inflammatory bowel diseases? A meta-analysis. J Dig Dis 2015;16:634-641.
  28. Lorusso D, Leo S, Mossa A, Misciagna G, Guerra V. Cholelithiasis in inflammatory bowel disease. A case-control study. Dis Colon Rectum 1990;33:791-794.
  29. Jeong YH, Kim KO, Lee HC, et al. Gallstone prevalence and risk factors in patients with ulcerative colitis in Korean population. Medicine (Baltimore) 2017;96:e7653.
  30. Bennett RC, Hughes ES. Urinary calculi and ulcerative colitis. Br Med J 1972;2:494-496.
  31. Knudsen L, Marcussen H, Fleckenstein P, Pedersen EB, Jarnum S. Urolithiasis in chronic inflammatory bowel disease. Scand J Gastroenterol 1978;13:433-436.
  32. Gelzayd EA, Breuer RI, Kirsner JB. Nephrolithiasis in inflammatory bowel disease. Am J Dig Dis 1968;13:1027-1034.
  33. Maratka Z, Nedbal J. Urolithiasis as a complication of the surgical treatment of ulcerative colitis. Gut 1964;5:214-217.
  34. Kennedy HJ, Al-Dujaili EA, Edwards CR, Truelove SC. Water and electrolyte balance in subjects with a permanent ileostomy. Gut 1983;24:702-705.
  35. Hutchinson R, Tyrrell PN, Kumar D, Dunn JA, Li JK, Allan RN. Pathogenesis of gall stones in Crohn's disease: an alternative explanation. Gut 1994;35:94-97.
  36. Parks JH, Worcester EM, O'Connor RC, Coe FL. Urine stone risk factors in nephrolithiasis patients with and without bowel disease. Kidney Int 2003;63:255-265.
  37. Kane S. Urogenital complications of Crohn's disease. Am J Gastroenterol 2006;101(12 Suppl):S640-S643.
  38. Mukewar S, Hall P, Lashner BA, Lopez R, Kiran RP, Shen B. Risk factors for nephrolithiasis in patients with ileal pouches. J Crohns Colitis 2013;7:70-78.
  39. Cury DB, Moss AC, Schor N. Nephrolithiasis in patients with inflammatory bowel disease in the community. Int J Nephrol Renovasc Dis 2013;6:139-142.
  40. Shea JA, Berlin JA, Escarce JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994;154:2573-2581.
  41. Barakos JA, Ralls PW, Lapin SA, et al. Cholelithiasis: evaluation with CT. Radiology 1987;162:415-418.
  42. Coursey CA, Casalino DD, Remer EM, et al. ACR Appropriateness Criteria® acute onset flank pain--suspicion of stone disease. Ultrasound Q 2012;28:227-233.
  43. Fulgham PF, Assimos DG, Pearle MS, Preminger GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol 2013;189:1203-1213.