No association between gallstones and gastroesophageal reflux disease

OBJECTIVES: Gallstones and hiatal hernia reportedly have been linked to sim ilar dietary factors prevalent in western countries, and patients with chol elithiasis or previous cholecystectomy have been reported to have more duod enogastric reflux than healthy controls. Nonetheless, the contribution of d uodenogastric reflux to the development of gastroesophageal reflux disease (GERD) remains controversial. The present study was aimed to assess the ass ociation between gallstone disease and GERD. METHODS: Outpatients from general medical clinics who underwent upper GI en doscopy and abdominal ultrasonography were recruited into a case-control st udy. A case population of 790 patients with various grades of GERD was comp ared to a control population of 407 patients without GERD. In a multivariat e logistic regression, the presence of GERD served as the outcome variable, whereas the presence of gallstones, hiatal hernia, social habits, and demo graphic characteristics served as predictor variables. RESULTS: No associations were found between the presence of cholelithiasis or previous cholecystectomy and GERD or between the presence of cholelithia sis or previous cholecystectomy and hiatal hernia. The severity of GERD als o remained unaffected by the presence of gallstones. The occurrence of GERD was influenced only by hiatal hernia (odds ratio [OR] = 3.15, 95% CI = 2.4 4-4.08), alcohol consumption (OR = 1.47, CI = 1.08-1.99), and not by cholel ithiasis (OR = 1.02, CI = 0.68-1.51), or cholecystectomy (OR = 0.90, CI = 0 .64-1.28). The frequency of GERD among hiatus hernia patients with gallston es (437/592 = 74%) was similar to the frequency of GERD among hiatus hernia patients without gallstones (168/220 = 76%, p = 0.516). CONCLUSIONS: Neither cholelithiasis nor cholecystectomy poses a risk for th e occurrence of GERD or hiatal hernia. Gallstone disease does not seem to i nfluence the integrity of the esophageal mucosa through GERD. (Am J Gastroe nterol 2001;96:2858-2862. (C) 2001 by Am. Coll. of Gastroenterology).