Age and incidence of occult pancreaticobiliary reflux in patients with benign gallbladder diseases

Abstract

Background: Occult pancreaticobiliary reflux (OPBR) has a significant correlation with diseases of the gallbladder and biliary system. This study examined the incidence of OPBR by age in patients with benign gallbladder diseases. Methods: We assessed 475 patients with benign gallbladder diseases who underwent surgery at Shanghai East Hospital from December 2020 to December 2021. Bile samples collected during surgery were tested for amylase. Patients with bile amylase >110 U/L (n = 64) were classified as the OPBR group; the rest (n = 411) as controls. Results: Of the participants, 375 had gallbladder stone (GS), 170 had gallbladder polyp (GP), and 49 had gallbladder adenomyomatosis (GA). The OPBR group was generally older, with OPBR incidence increasing with age, peaking post-45. Rates by age were: 4.9% (<35), 5.2% (35–44), 20.7% (45–54), 22.5% (55–64) and 17.6% (≥65), mainly in GS patients. ROC analysis for predicting OPBR by age yielded an area under the curve of 0.656, optimal cut-off at 45 years. Logistic regression indicated age > 45, GP, male gender, and BMI ≥ 24 kg*m⁻² as independent OPBR predictors in GS patients. Based on these variables, a predictive nomogram was constructed, and its effectiveness was validated using the ROC curve, calibration curve and decision curve analysis (DCA). Further stratification revealed that among GS patients ≤ 45, concurrent GA was an OPBR risk; for > 45, it was GP and male gender. Conclusions: The incidence of OPBR in GS patients is notably influenced by age, with those over 45, especially males without GP, being at heightened risk.

Keywords:

• Gallbladder stone
• occult pancreaticobiliary reflux
• age
• gallbladder polyp
• gallbladder adenomyomatosis

Author contributions

Yukai Xiang, Chen Qiu, Cheng Zhang and Yulong Yang contributed to the study concept and design including collecting the primary data and drafting the manuscript. Yubin Wang and the remaining authors contributed to data collection and sample testing. All the authors have read and approved the final manuscript.

Disclosure statement

The authors declare no conflict of interest.

Additional information

Funding

This study was funded by Key Specialty Construction Project of Shanghai Pudong New Area Health Commission (Grant No. PWZzk2022-17); Shanghai East Hospital Clinical Research Project (Grant No. DFLC2022019); the Featured Clinical Discipline Project of Shanghai Pudong District (Grant No. PWYts2021-06); Shanghai East Hospital Research Initiation Fund (Grant No. DFRC2018014).