Most Read Articles
Naomi Rodrig, 09 Oct 2017

New endoscopic technologies have improved outcomes for patients with upper gastrointestinal bleeding (UGIB), according to Professor James Lau from the Chinese University of Hong Kong, who reviewed current treatment practices and latest advances at the Asian Pacific Digestive Week (APDW) 2017 held recently in Hong Kong.

30 Oct 2017
Children with autism spectrum disorders (ASD) appear to have significantly altered gut mucosal mitochondrial function compared with controls and other children with nonspecific gastrointestinal symptoms, a recent study shows.
Jairia Dela Cruz, 07 Oct 2017
Serum albumin appears to be useful in predicting early mortality in Asian patients with severe hypoxic hepatitis, with low baseline levels entailing a fivefold increase in risk of death, as shown in a Singapore study.
29 Aug 2015
Non-operative management of acute pancreatitis substantially decreased exocrine and endocrine dysfunction compared with operative method, a recent study shows.

HRT associated with cholelithiasis risk

Audrey Abella
21 Apr 2017

Hormone replacement therapy (HRT), but not oral contraceptives (OC), could lead to the development of gallstones, a recent study has found.

In this meta-analysis, exogenous oestrogen intake was associated with risk of cholelithiasis (pooled risk ratio [RR], 1.59, 95 percent confidence interval [CI], 1.44–1.75). [Medicine (Baltimore) 2017;96:e6556]

However, on subgroup analysis, risk of cholelithiasis was significantly associated with HRT (pooled RR, 1.79, 95 percent CI, 1.61–2.00) but not with OC (pooled RR, 1.19, 95 percent CI, 0.97–1.45).

“[Our study] indicates that OC is not the risk factor for cholelithiasis, which will be beneficial to eliminate the bias for the OC. As for the HRT, our results proved it can significantly increase the incidence of cholelithiasis,” said the researchers.

Results from the researchers’ original study conducted on a postmenopausal Chinese female population further support these findings, which revealed a high risk of cholelithiasis with HRT (RR, 2.01, 95 percent CI, 1.43–2.83 for <2 years and RR, 1.78, 95 percent CI, 1.02–3.60 for ≥2 years) and OC intake (RR, 1.23, 95 percent CI, 0.90–1.68 for <1 year and RR, 1.52, 95 percent CI, 0.64–3.60 for ≥1 year).

Previous studies evaluating the molecular mechanism of oestrogen in the bile duct and gall bladder revealed G protein-coupled receptor 30 and oestrogen receptor α as influential in lipid metabolism, which could increase the likelihood of gallstone formation. [Biochim Biophys Acta 2015;1852:2161-2169; Gastroenterology 2015;148:S295; J Lipid Res 2015;56:1691-700]

Researchers evaluated 19 studies comprising participants aged 14–80 years who were on OC or HRT. Of note is one study that reported oestrogen use in males with prostate cancer, implying that oestrogen could also be a potential risk factor for gallstones in the male population. [J Clin Invest 1989;84:811-816] Further studies are warranted to verify this theory, noted the researchers.

Exogenous oestrogen has been associated with more serious cancer risks (eg, breast, ovarian, endometrial), but its effect on gallstone formation has not been extensively studied. Furthermore, previous studies have shown both positive and negative associations between gallstone formation and HRT and OC intake. [Drug Saf 2013;36:1189-1197; JAMA 2005;293:330-339; Scand J Gastroenterol 2014;49:109-113; Ann Intern Med 2001;135:493-501]

Therefore, it is important to establish a definitive link between cholelithiasis and oestrogen therapy to help clinicians in the management of gallstones, said the researchers, adding that this could raise awareness for overweight women under exogenous oestrogen therapy.

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Naomi Rodrig, 09 Oct 2017

New endoscopic technologies have improved outcomes for patients with upper gastrointestinal bleeding (UGIB), according to Professor James Lau from the Chinese University of Hong Kong, who reviewed current treatment practices and latest advances at the Asian Pacific Digestive Week (APDW) 2017 held recently in Hong Kong.

30 Oct 2017
Children with autism spectrum disorders (ASD) appear to have significantly altered gut mucosal mitochondrial function compared with controls and other children with nonspecific gastrointestinal symptoms, a recent study shows.
Jairia Dela Cruz, 07 Oct 2017
Serum albumin appears to be useful in predicting early mortality in Asian patients with severe hypoxic hepatitis, with low baseline levels entailing a fivefold increase in risk of death, as shown in a Singapore study.
29 Aug 2015
Non-operative management of acute pancreatitis substantially decreased exocrine and endocrine dysfunction compared with operative method, a recent study shows.