Global prevalence and gastrointestinal symptom burden of individuals with a history of cholecystectomy

BACKGROUND: Cholecystectomy is commonly performed globally, and many patients with disorders of gut-brain interaction (DGBI) report that their symptoms have either preceded or developed following cholecystectomy. OBJECTIVE: To determine the global prevalence of a self-reported history of a cholecystectomy and investigate its association with fulfilling Rome IV diagnostic criteria for DGBI. DESIGN: First, we used population-based internet questionnaire data from the Rome Foundation Global Epidemiology Study (n=54 127) to calculate the cross-sectional prevalence of a self-reported history of cholecystectomy. Second, we compared the prevalence of meeting diagnostic criteria for DGBI by cholecystectomy, using logistic regression models to calculate ORs before and after adjusting (AOR) for potential confounders. RESULTS: We identified 2709 subjects with cholecystectomy, corresponding to a global prevalence of 5.0% (95% CI 4.8 to 5.2). Global differences followed an east to west gradient, ranging from 1.9% in Asia to 9.9% in North America. Cholecystectomy was associated with a higher prevalence of fulfilling symptom criteria for any DGBI (AOR 1.50, 56.2% with cholecystectomy vs 42.3% without cholecystectomy), with the highest AOR found for gastroduodenal (AOR 1.73; 19.9% vs 11.8%) and anorectal (AOR 1.71; 17.0% vs 8.4%) disorders, followed by oesophageal (AOR 1.47; 12.3% vs 6.6%) and bowel (AOR 1.38; 47.5% vs 35.4%) disorders. CONCLUSION: Cholecystectomy is prevalent worldwide and varies across world regions. A history of this procedure is associated with a higher GI symptom burden, either due to new cholecystectomy-related symptomatic conditions, or persistent DGBI misattributed to biliary disease for which a cholecystectomy was erroneously performed.