Is the incidence and risk of gallstones increased in ulcerative colitis?

Prevalence and Risk Factors of Gallstone Disease in Korean Patients with Ulcerative Colitis
Intest Res. 2025;23(4):455-463

Up to 50% of patients with inflammatory bowel disease (IBD) may develop hepatobiliary complications (EIMs), and gallstone disease is known to be one of the most common conditions.
Among these complications, the association between gallstone disease and Crohn’s disease (CD) has been more extensively studied than in ulcerative colitis (UC). The prevalence of gallstone disease has been reported to be higher in CD patients (1.8%–34.2%) compared with healthy individuals (0.7%–14.9%). However, UC is also associated with hepatobiliary complications, including gallstone disease, although its specific risk factors remain unclear.
In this retrospective study, authors analyzed 2,811 Korean patients with UC who were diagnosed with gallstone disease through imaging tests. The incidence and associated risk factors of gallstone disease were evaluated according to age, disease extent, medication history, and surgical history.

Gallstone disease occurred in 7% of Korean patients with ulcerative colitis, a prevalence higher than that of the general population.
Older age (≥60 years), primary sclerosing cholangitis (PSC), and a history of colectomy were identified as independent risk factors for gallstone development.
Patients with PSC or a history of colectomy showed a significantly higher cumulative risk of gallstone disease.
Regular abdominal imaging is recommended for high-risk UC patients to facilitate early detection and management.

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