Periodontitis as a potential predisposing factor for gallstone cholecystitis: exploring the role of chronic systemic inflammation

PURPOSE: Periodontitis is a chronic oral disease that contributes to low-grade systemic inflammation and may predispose to extraoral complications. We conducted this study to analyze its association with gallstone-related cholecystitis. METHODS: The subjects of this prospective observational study were 160 adults with acute calculous cholecystitis or symptomatic cholelithiasis. The patients were grouped according to their periodontal status as having “normal/mild” or “moderate/severe” peridontitis. We calculated the inflammatory indices: the lymphocyte-to-C-reactive protein ratio (LCR), neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), and platelet-to-lymphocyte ratio (PLR); and analyzed the associations between periodontal status, inflammatory markers, and gallbladder pathology, using univariate and multivariate models. RESULTS: Moderate/severe periodontitis was found significantly more frequently in patients with cholecystitis than in those with uncomplicated gallstones (80% vs. 22.5%, p < 0.001). Patients with cholecystitis had lower LCR and higher NLR, d-NLR, and PLR values (all p < 0.05). Multivariate analysis identified periodontitis (HR = 1.797) and all inflammatory markers as independent predictors of cholecystitis. Severe periodontitis was especially prevalent in patients with active acute cholecystitis. CONCLUSION: Periodontitis is significantly associated with acute cholecystitis, potentially through systemic inflammatory mechanisms. Thus, periodontal evaluation may be important in the management and prevention of biliary tract complications.