PREVALENCE OF CHOLELITHIASIS ACCORDING TO ALCOHOLIC LIVER-DISEASE - APOSSIBLE ROLE OF APOLIPOPROTEINS AI AND AII

Moderate alcohol intakes decreases the risk of gallstones; in contrast , the prevalence of gallstones is increased in patients with alcoholic cirrhosis. The aims of this prospective study were to assess the prev alence of cholethiasis among drinkers according to the histological se verity of liver disease, and to estimate the importance of serum apoli poproteins Al and apolipoprotein All as risk factors for gallstones. A mong the 320 drinkers included, 53 patients had cholelithiasis. The pr evalence increased (p < 0,0001) from 5% in patients with normal liver (1 of 22) and 6% in patients with steatosis only (3 of 47) to 13% in p atients with fibrosis (7 of 54), reaching 27% among patients with biop sy-proven cirrhosis (28 of 103). Among patients with clinically obviou s cirrhosis on whom biopsy was not performed mainly because of the sev erity of liver disease, the prevalence of cholelithiasis reached a max imum of 46% (6 of 13). Among drinkers with nonsevere liver disease, pa tients with cholelithiasis were older (59 +/- 9 years, mean +/- SD vs. 45 +/- 11, p = 0.003) with lower apolipoprotein Al (118 +/- 37 vs. 16 3 +/- 45 mg/dl; p = 0.002) and apolipoprotein All (30 +/- 12 vs. 53 +/ - 20 mg/dl; p = 0.0002) in comparison with patients without cholelithi asis. These differences persisted after considering by multiple logist ic regression analysis, sex, and ideal body weight, Alcohol consumptio n during the last 5 years was lower in patients with cholelithiasis (8 3 g/day) in comparison with patients without cholelithiasis (142 g/day ; p = 0.04). Among drinkers with severe liver disease, patients with c holelithiasis were slightly order (56 +/- 13 vs. 52 +/- 12 years; p = 0.07) and were more often female (46% vs. 29%; p = 0.06). Unconjugated serum bilirubin was also slightly higher (30 +/- 43 vs. 19 +/- 40 mu mol/liter; p = 0.08). In conclusion, alcohol intake could protect drin kers against cholesterol gallstones as long as apolipoprotein Al and a polipoprotein All secretions are increased. In contrast, heavy ethanol -induced fibrosis in the river results in decreased apolipoprotein Al and apolipoprotein All secretions and thus, may promote the occurrence of cholesterol gallstones, These relationships could explain the para dox of decrease gallstones prevalence among moderate drinkers and the high prevalence among alcoholic cirrhotics.