Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2015; 21(29): 8912-8919
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8912
Helicobacter pylori infection is associated with gallstones: Epidemiological survey in China
Fen-Ming Zhang, Chao-Hui Yu, Hong-Tan Chen, Zhe Shen, Feng-Ling Hu, Xiao-Ping Yuan, Guo-Qiang Xu
Fen-Ming Zhang, Chao-Hui Yu, Hong-Tan Chen, Zhe Shen, Feng-Ling Hu, Guo-Qiang Xu, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Xiao-Ping Yuan, Department of International Health Care Center, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Xu GQ proposed the study; Zhang FM, Chen HT and Hu FL collected the data; Zhang FM, Yu CH, Shen Z and Yuan XP analyzed and interpreted the data; Zhang FM drafted the manuscript; Xu GQ revised the manuscript; all the authors contributed to the design of the study and interpretation of the data, and read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang University School of Medicine.
Informed consent statement: All participants were informed verbally about the purpose and design of the study. Written informed consent was not required due to the observational nature of the study. The personal information of each participant was anonymized at collection or prior to analysis.
Conflict-of-interest statement: The authors declared that there is no competing interests in this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at xuguoqi@mail.hz.zj.cn. All participants were informed verbally about the purpose and design of the study. Written informed consent was not required due to the observational nature of the study. The personal information of each participant was anonymized at collection and anonymized prior to analysis and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Guo-Qiang Xu, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. xuguoqi@mail.hz.zj.cn
Telephone: +86-571-87236718 Fax: +86-571-87236718
Received: December 23, 2014
Peer-review started: December 24, 2014
First decision: February 10, 2015
Revised: March 16, 2015
Accepted: April 28, 2015
Article in press: April 28, 2015
Published online: August 7, 2015
Processing time: 227 Days and 16.4 Hours
Abstract

AIM: To elucidate the prevalence and risk factors for gallstones, primarily focusing on Helicobacter pylori (H. pylori) infection.

METHODS: A total of 10016 Chinese subjects, who had undergone physical examination, fasting 13C urea breath test and abdominal ultrasonography, had sufficient blood test data, and had finished a questionnaire, were included in this cross-sectional study. Participants (n = 1122) who had previous eradication of H. pylori were studied separately.

RESULTS: Gallstones were discovered in 9.10% of men and 8.58% of women, with no significant sex difference. Multivariate analyses displayed that age, aspartate aminotransferase, total cholesterol, H. pylori infection, hepatitis C virus (HCV) infection, and fatty liver had a significant association with gallstones (P < 0.05). Successive multiple logistic regression analysis including index of odds ratio (OR) and standardized coefficient (β) indicated that older age (OR/β = 1.056/0.055), H. pylori infection (OR/β = 1.454/0.109), HCV infection (OR/β = 1.871/0.123), and fatty liver (OR/β = 1.947/0.189) had a significant positive association with gallstones. After age stratification, H. pylori infection and fatty liver still had a significant positive association with gallstones in any age-specific groups, whereas HCV infection had a significant positive association in patients aged > 40 years. The prevalence of gallstones among H. pylori-positive, H. pylori-eradicated, and H. pylori-negative subjects was 9.47%, 9.02%, and 8.46%, respectively. The matched analysis showed that gallstones among H. pylori eradicated subjects was significantly lower compared with H. pylori-positive subjects (P < 0.05).

CONCLUSION: H. pylori infection and fatty liver have a significant positive association with gallstones. H. pylori eradication may lead to prevention of gallstones.

Keywords: Gallstones; Helicobacter pylori; Cross-sectional study

Core tip: Although the pathogenesis of gallstones remains obscure, chronic infection is already accepted as a potential risk factor. There are few large surveys analyzing background factors related to gallstones in Asia. Our study evaluated background factors associated with the presence of gallstones in a cohort of > 10000 subjects, and analysis focusing on the association between Helicobacter pylori (H. pylori) infection and gallstones in the Chinese population is the most important feature of our study. In this large survey, we found that H. pylori eradication may lead to prevention of gallstones, which should shed light on the pathophysiology of gallstones.