Should We Screen Crohn’s Patients for Gallstones?

Review by Prof. Angela Carbajal (Peru)

Study Summary 

Gallstones have long been recognized as a possible complication in Crohn’s disease (CD), but which patients are truly at risk? In this systematic review and meta-analysis, Gong and colleagues pooled data from 11 studies involving 3,588 CD patients to quantify both prevalence and risk. About 14.7% of CD patients were found to have gallstones. Risk increased significantly with age ≥ 40, disease duration > 15 years, ileocolonic or ileocecal disease location, history of bowel surgery, multiple hospitalizations, corticosteroid or immunomodulator use, and TPN use. Surprisingly, BMI and sex—factors often linked to gallstones in the general population—were not significant here.

These findings offer a clearer picture of which CD patients may be most vulnerable to gallstone-related complications. Although most studies came from Europe, the consistent patterns point toward real clinical implications. Prophylactic strategies and targeted screening might be warranted, especially in patients with long-standing, complicated disease.

Commentary 

There’s something both expected and eye-opening in this study. Gallstones are a known complication in Crohn’s disease—but this analysis puts numbers and weight behind that connection. Age, long-standing disease, ileocecal involvement, and TPN aren’t just markers of severity—they also predict a higher risk of gallstones. What stands out is how consistently these patterns emerged across studies. While most studies are European, limiting global translation, the clinical message is clear: we may need to rethink when and whom we screen. Should prophylactic strategies be on the table? For high-risk Crohn’s patients, especially those facing surgery or TPN, future studies must explore these risks in diverse populations and assess the value of interventions like ursodeoxycholic acid or prophylactic cholecystectomy. In Crohn’s, the gallbladder deserves more of our attention.

Citation

https://pubmed.ncbi.nlm.nih.gov/39322804/

Gong Y, He Y, Wan M, Chen H. Risk Factors for Gallstones in Crohn's Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2024;69:4187-4202. doi: 10.1007/s10620-024-08597-1. Epub 2024 Sep 25. PMID: 39322804.

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