Cholecystectomy linked with disease activity in Crohn’s
Cholecystectomy in patients with Crohn’s disease was associated with markers of disease activity and worse quality of life in a multi-year study.
Filippos Koutroumpakis, MD, from the University of Pittsburgh division of gastroenterology, hepatology and nutrition, said in a recorded presentation that removing the gallbladder allows for continuous drainage of bile acid into the gastrointestinal tract leading to the development of secondary bile acids, which have been shown to cause gene mutations and adenomas in animal studies.
“In human clinical studies in otherwise healthy individuals, the effect of cholecystectomy in colon dysplasia is debated. However, in this study, we focused not on patients with normal gastrointestinal physiology, but in patients with Crohn’s disease,” he said. “It’s well known that Crohn’s disease in the terminal ilium leads to malabsorption of bile acids, causing bile acid diarrhea and oversaturation of the bile with cholesterol, leading to gallstone disease.”
To explore the relationship of cholecystectomy and CD, researchers used a prospective registry of patients with CD who had been followed at a tertiary center. They grouped patients based on whether or not they had undergone cholecystectomy.
Investigators analyzed biochemical and histologic data over multiple years and used the Harvey-Bradshaw index (HBI) and Short Inflammatory Bowel Disease Questionnaire (SIBDQ) to assess disease course and quality of life.
Of 834 total patients, 151 had undergone cholecystectomy (18%).
Koutroumpakis and colleagues found that history of cholecystectomy was associated with higher disease activity based on mean HBI (P < .001), more years with anemia (P = .048), lower albumin (P = .001), worse quality of life based on mean SIBDQ (P < .001), higher risk for incident colonic dysplasia (P = .011), higher rates of annual hospital admissions (P = .004) and opioid use (P < .048).
After controlling for age, sex, tobacco use and BMI, cholecystectomy remained associated with higher disease activity, lower albumin, lower quality of life and more hospital admissions.
“Cholecystectomy was associated with deterioration of quality of life, increased disease activity and higher rates of health care utilization,” Koutroumpakis said. “Furthermore, when Crohn’s disease involved the terminal ilium, cholecystectomy significantly increased the risk for colonic dysplasia.”
Read Cholecystectomy linked with disease activity in Crohn’s by Alex Young.