Concomitant Gallstone Disease Was Associated With a Worse Prognosis in Non-Cirrhotic Patients With Primary Biliary Cholangitis

Abstract Background & Aims: Primary biliary cholangitis (PBC) is a rare disease manifested as intrahepatic cholestasis, whereas gallstone disease is a common disease. Little is known on the prevalence and impact of gallstone disease (GD) on the clinical course of PBC. Therefore, we investigated the prevalence and the impact of GD on the prognosis of PBC in cirrhotic and non-cirrhotic PBC patients in China.Methods: We retrospectively enrolled PBC patients and followed them by reviewing of electronic records and structured, standardized telephone interviews. GD was defined as gallstones demonstrated on ultrasonography or history of cholecystectomy for gallstones. The primary endpoints of the present study were liver-related death and/or liver transplantation.Results: Among 985 PBC patients enrolled in the present study, 258 (26.2%) had GD, with 157 (22.9%) in non-cirrhotic patients and 101 (33.8%) in cirrhotic patients. No difference was observed in the prevalence of GD between women and men (p>0.05). Compared with PBC patients without GD, those with GD were older, more often coexistent type 2 diabetes, and had a more severe liver disease at baseline. Furthermore, those with GD had lower transplant-free survival and higher incidence of hepatic events in non-cirrhotic PBC patients (both p<0.05). Multivariate Cox regression showed that concomitant GD, older age, male sex, and higher bilirubin were independent risk factors associated with transplant-free survival in non-cirrhotic PBC patients. Conclusions: Concomitant GD was common and an independent risk factor that associated with a worse prognosis in non-cirrhotic PBC patients.