Gallbladder Disease among Obese Patients in Taiwan

Background: Obesity is a risk factor for gallbladder
disease. The authors analyze the prevalence and clinicopathology
of gallbladder disease among obese
patients in Taiwan.
Methods: Prevalence and various clinical factors
associated with cholelithiasis were studied in 199
patients who were undergoing bariatric surgery for
obesity. Clinical data (gender, age, BMI and associated
diseases), laboratory evaluation and immunoglobulin
G antibodies against Helicobacter pylori were
obtained from the patient records. The histopathologic
findings of the gallbladder were also examined retrospectively.
The degree of acute inflammation, chronic
inflammation, cholesterolosis, cholesterol polyp
and gastric metaplasia was determined and scored.
Results: Of the patients, 91% (n=181) were females
and 9% (n=18) were males, age 34.26 ± 8.41 years,
with mean BMI 35.28 ± 6.11 kg/m2. The prevalence of
cholelithiasis was 10.1%. Increased diastolic blood
pressure and HBsAg carrier were the only significant
factors associated with cholelithiasis. All obese
patients in our study presented with variable degrees
of chronic mononuclear cell infiltration in the gallbladder
mucosa. Cholesterolosis was present in 100
patients (50.3%), followed by gastric metaplasia
(27.1%), cholesterol polyp (16.1%) and acute inflammation
(9.5%). Multivariate analysis showed an association
between cholelithiasis and acute and chronic
inflammation. The predictors of cholesterolosis were
BMI, waist circumference and high-sensitivity C-reactive
protein. The seroprevalence of H. pylori was
42.2%. Older age, abnormal liver function tests, calcium
and HBsAg carrier were significantly different
between H. pylori-seropositive and H. pylori-seronegative
obese patients. However, we could rarely find H.
pylori within the gallbladder mucosa.
Conclusion: Cholelithiasis in Asian obese patients
is significantly associated with increased diastolic
blood pressure and hepatitis B surface antigen carriers.
Because chronic liver disease seems to be a risk
factor for cholelithiasis in both non-obese and obese
populations, prophylactic cholecystectomy can be
considered in obese patients with HBsAg positivity.
We did not find evidence that H. pylori has a role in
the pathogenesis of gallbladder disease and gallstone
by histologic and serologic examinations.
Furthermore, mucosal abnormalities of acute and
chronic inflammatory cell infiltration are common in
obese patients, which related to cholelithiasis