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Increased risk of de novo inflammatory bowel disease following cholecystectomy: a population-based analysis
Saqr Alsakarneh1, Razan Aburumman1,2, June Tome1
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (Saqr Alsakarneh, Razan Aburumman, June Tome, Michael Camilleri).
Background:
Cholecystectomy (CCY) may alter bile acid flow and gut microbiota, increasing the risk of gastrointestinal disease. Prior studies have suggested that CCY may be associated with bile acid diarrhea and microscopic colitis; however, the association with the new diagnosis of inflammatory bowel disease (IBD) remains unstudied. In this study, we evaluated whether CCY was associated with a greater risk of de novo IBD.
Methods:
We conducted a retrospective cohort study, analyzing data from the TriNetX network (2010-2024), using 1:1 propensity score matching between adult patients undergoing CCY and controls, based on variables that included demographics, comorbidities and medication use. The primary outcome was risk of de novo IBD. Secondary outcomes included the risk of developing ulcerative colitis (UC) or Crohn's disease (CD). Kaplan-Meier analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) was used to compare time-to-event rates.
Results:
Among 570,317 matched pairs, CCY was associated with a greater risk of IBD (adjusted HR [aHR] 1.29, 95%CI 1.22-1.35; P<0.001), and specifically CD (aHR 1.83, 95%CI 1.69-1.99; P<0.001), but not the risk of UC. This elevated risk persisted across both sexes and all age groups. Among patient characteristics, tobacco use was associated with the greatest additional risk of IBD post-CCY (aHR 1.43, 95%CI 1.19-1.76; P<0.001).
Conclusions:
Prior CCY is associated with a greater risk of CD but not UC. These findings support the need for a low threshold to think about CD in patients with gastrointestinal symptoms after CCY.
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