Typhoid carriers among patients with gallstones are at increased risk for carcinoma of the gallbladder

OBJECTIVE: The aim of this study was to identify risk factors for carcinoma of the gallbladder (CaGB) among patients with gallstones (GS) with special reference to role of chronic Salmonella typhi carrier state. METHODS: A prospective case-control study was conducted in a tertiary care center in India. Cases were defined as consecutive patients with CaGB and G S, whereas controls were patients with GS alone. All were assessed clinical ly and their demographic data, diet, and smoking history recorded. Patients were detected to he typhoid carriers on the basis of Vi serology by enzyme linked immunosorbent assay. Cases (n = 37) and controls (n = 80) were comp ared by univariate and logistic regression analysis. RESULTS: The mean age of the cases and the controls were 53.4 +/- 11 yr and 43.5 +/- 14 yr, respectively Among the cases, six (16%) patients were dete cted to be typhoid carriers, in contrast to two (2.5%) among controls (p = 0.01). Compared to controls, cases were more often older (p = 0.0002), of a lower socioeconomic status (p = 0.0005), and smokers (p = 0.0002). Stepwis e logistic regression analysis identified typhoid carrier state (OR = 14; C I 2-92), age greater than or equal to 47 yr (OR = 5; CI 2-14) and smoking ( OR = 11; CI 2-71) as the three independent risk factors for development of CaGB among patients with GS. CONCLUSION: Chronic typhoid carrier state was the most important risk facto r among patients with CaGB and gallstones. (Am J Gastroenterol 2000;95:784- 787, (C) 2000 by Am. Coll. of Gastroenterology).