Effect of Estrogen Therapy on Gallbladder Disease

Abstract

Context Estrogen therapy is thought to promote gallstone formation and cholecystitis but most data derive from observational studies rather than randomized trials.Objective To determine the effect of estrogen therapy in healthy postmenopausal women on gallbladder disease outcomes.Design, Setting, and Participants Two randomized, double-blind, placebocontrolled trials conducted at 40 US clinical centers. The volunteer sample was 22579 community-dwelling women aged 50 to 79 years without prior cholecystectomy.Intervention Women with hysterectomy were randomized to 0.625 mg/d of conjugated equine estrogens (CEE) or placebo (n=8376). Women without hysterectomy were randomized to estrogen plus progestin (E+P), given as CEE plus 2.5 mg/d of medroxyprogesterone acetate (n=14203). Main Outcome MeasuresParticipants reported hospitalizations for gallbladder diseases and gallbladder-related procedures, with events ascertained through medical record review. Cox proportional hazards regression was used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) using intention-to-treat and time-to-event methods. ResultsThe CEE and the E+P groups were similar to their respective placebo groups at baseline. The mean follow-up times were 7.1 years and 5.6 years for the CEE and the E+P trials, respectively. The annual incidence rate for any gallbladder event was 78 events per 10000 person-years for the CEE group (vs 47/10000 person-years for placebo) and 55 per 10000 person-years for E+P (vs 35/10000 person-years for placebo). Both trials showed greater risk of any gallbladder disease or surgery with estrogen

Cholelithiasis: causative factors, clinical manifestations and management

“…A study by Cirillo et al suggested a causal association between estrogen and gallstone disease indicating the cause of preponderance. 11 This finding is consistent with the literature like Alghaythi et al and Sun et al with male: female ratio of 1:1.5 and 1:1.27 respectively. 12,13 In the present study, although the number of patients with BMI >25 were 58.70% as compared to 41.30% of patients with normal BMI (<25), this difference was not statistically significant.…”

Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study

“…Use of hormone replacement therapy by postmenopausal women increases the risk of gallbladder disease. This finding agrees with previous reports 12 3 4 We also found a substantially lower risk of gallbladder disease with use of transdermal therapy than with oral therapy (relative risk 1.17 v 1.74).…”

Frequency of Cholelithiasis in Patients with Chronic Liver Disease: A Hospital-Based Study

“…This result was consistent with the study of Cirillo et al which proved that women on long term oral contraceptives have a two folds increased incidence of cholelithiasis over controls and postmenopausal women taking estrogen-containing drugs have a significant increase frequency (around 1.8 times) of cholelithiasis [20].…”