Co-occurrence of autoimmune liver disease and gallstones: a clinically overlooked phenomenon

Gallstone disease is a relatively common complicating condition in patients with autoimmune liver disease (AILD) in clinical practice, yet this phenomenon has not been reported previously. Thus, we investigated the prevalence and the clinical characteristics of gallstones in patients with AILD.

We retrospectively analyzed 560 patients with AILD, comprising 207 with primary biliary cholangitis (PBC), 289 with autoimmune hepatitis (AIH), and 64 with PBC-AIH overlap syndrome (PBC-AIH), who attended the General Hospital of Tianjin Medical University from November 2012 to October 2022. In addition, 937 control (CTRL) individuals matched for age and sex were included.

The proportion of patients with AILD, PBC, AIH, and PBC-AIH complicated by gallstones was 32.5, 35.7, 28.4, and 40.6%, significantly higher than in the CTRL (14.3%). Types of gallstones are predominantly multiple stones (43.4%), followed by single stones (32.4%) and sludge stones (6%). Patients with AILD with gallstones exhibited significantly higher age at the first visit ( P  = 0.007) and serum biochemical markers associated with bile duct injury, such as gamma-glutamyl transpeptidase ( P  = 0.003) and alkaline phosphatase ( P  = 0.001). Patients with AILD aged 61.5 and older were significantly more prone to gallstones ( P  = 0.003).

Gallstones are a common comorbidity in patients with AILD, predominantly multiple stones. Patients with gallstones should be aware of the early diagnosis of AILD to prevent delayed treatment. Older patients with AILD should be alerted and prevented from developing stones. Our findings provide new ideas for clinical diagnosis and etiologic investigation.