Gastrointestinal resection is associated with urolithiasis severity among inflammatory bowel disease patients

A well-established correlation exists between Inflammatory Bowel Disease (IBD) and urolithiasis. However, the influence of surgical history on the severity of urolithiasis in IBD patients remains underexplored. This study aims to investigate the association between gastrointestinal (GI) bowel resection and urolithiasis severity in patients with IBD.

This retrospective cohort study analyzed 42 patients diagnosed with both IBD and urolithiasis between 2016 and 2024. Patients were categorized based on their history of bowel resection. Primary outcomes included maximal stone burden, need for urolithiasis surgery, and stone recurrence. Secondary outcomes were stone-related clinical events, multiple urolithiasis surgeries, and having a percutaneous nephrolithotomy. Associations between bowel resections and outcomes were assessed using univariate and multivariate regression analyses.

The median age was 55 years (range 45-68), with 76% having Crohn's disease and 24% ulcerative colitis. Of the cohort, 48% had a history of a bowel resection (14 small bowel, 9 ileocolic resection (ICR), 10 subtotal/total colectomy), with 31% having multiple resections. The median interval between bowel resection and urolithiasis diagnosis was 8 years (5-22). Patients with prior bowel resections had significantly higher stone burden (p < 0.001), greater need for urolithiasis surgery (p = 0.03), and increased stone recurrence rates (p = 0.006). On multivariate analysis, bowel resections independently predicted adverse urolithiasis outcomes, with small bowel resections and ICR showing stronger associations than colectomies.

Bowel resections are linked to increased urolithiasis severity in IBD patients. These findings highlight the need for proactive preventative therapies and stricter surveillance protocols for IBD patients undergoing bowel resection.