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GLOBAL PREVALENCE AND GASTROINTESTINAL SYMPTOM BURDEN OF INDIVIDUALS WITH A HISTORY OF CHOLECYSTECTOMY: A POPULATION-BASED CROSS-SECTIONAL STUDY

Bo Konings 1, Lukas Balsiger 1, Jóhann Hreinsson 2, Shrikant Bangdiwala 3, Ami D. Sperber 4, Olafur S. Palsson 5, Magnus Simrén 2,5, Hans Törnblom 2, Jan Tack 1,2

Affiliations

1 Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium

2 Sahlgrenska University Hospital, Gothenburg, Sweden

3 McMaster University, Hamilton, Canada

4 Ben-Gurion University of the Negev, Farod, Israel

5 University of North Carolina, Chapel Hill, Chapel Hill, NC, United States

Summary

AI Generated

A global cross-sectional study of 54,127 individuals found that cholecystectomy, reported by 5.3% of respondents with substantial regional variation, was associated with higher prevalence of meeting symptom criteria for disorders of gut-brain interaction.

Cholecystectomy prevalence ranged from 2.1% in Asia to 10.3% in North America, demonstrating an East-West gradient.
Individuals with cholecystectomy had 57.1% prevalence of meeting DGBI symptom criteria versus 42.2% without cholecystectomy, with adjusted odds ratio of 1.57.
The strongest associations were observed for gastroduodenal and anorectal DGBI patterns (adjusted OR 1.88 for each), followed by esophageal (1.62) and bowel (1.43) patterns.
Notable increases were seen for pain-predominant diagnoses including reflux hypersensitivity, epigastric pain syndrome, and irritable bowel syndrome, as well as functional diarrhea, fecal incontinence, functional dysphagia, and cyclic vomiting syndrome.
This population-based epidemiological study provides clinicians and researchers with data on the association between cholecystectomy and functional gastrointestinal symptom patterns across multiple organ systems.

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Abstract

Introduction

Cholecystectomy is a common procedure globally, and many patients with disorders of gut-brain interaction (DGBI) report that symptoms have either preceded or developed following the procedure.

Aims & Methods

To determine the global prevalence of cholecystectomy and investigate its association with meeting symptom criteria for DGBI, we used population-based internet questionnaire data from the ROME Foundation Global Epidemiology Study, comprising of 54,127 subjects in 26 countries. First, we calculated the cross-sectional global and regional prevalence of a self-reported history of cholecystectomy. Second, we compared the prevalence of meeting symptom criteria for ROME IV DGBI¹ by cholecystectomy, using percentages and 95% confidence intervals (95% CI). We used logistic regression models to calculate Odds Ratios (OR) before and after adjusting (AOR) for age, sex, somatic symptoms (Physical Health Questionnaire 12 (PHQ12)), anxiety and depression (PHQ4), and ability to seek medical care (easily, with difficulty, or not).

Results

We identified 2,856 subjects with cholecystectomy, corresponding to a global prevalence of 5.3% [5.1-5.5]. An East-West gradient was observed, ranging from 2.1% [1.8-2.4] in Asia to 10.3% [9.4-11.3] in North America. A cholecystectomy was associated with a higher prevalence of meeting symptom criteria for a DGBI (57.1% vs 42.2%, AOR 1.57 [1.44-1.72]). Gastroduodenal and anorectal DGBI symptom patterns yielded the greatest association (AOR 1.88 [1.67-2.10]; 1.88 [1.67-2.11]), followed by symptom patterns compatible with esophageal (1.62 [1.41-1.85]) and bowel (1.43 [1.31-1.56]) DGBI. A notable increase was seen for pain-predominant diagnoses such as reflux hypersensitivity, epigastric pain syndrome, and irritable bowel syndrome, but also for functional diarrhea, fecal incontinence, functional dysphagia, and cyclical vomiting syndrome (Table 1).

Table 1. Symptom criteria met for DGBI by cholecystectomy

Symptom criteria met for DGBI	No cholecystectomy (N=51271)	Cholecystectomy (N=2856)	Odds Ratio (95% CI)	Adjusted Odds Ratio (95% CI)
Any DGBI	42.2% (41.8-42.6)	57.1% (55.3-58.9)	1.82 (1.69, 1.97)	1.57 (1.44, 1.72)
Esophageal DGBI Functional Heartburn Functional Chest Pain Reflux Hypersensitivity Globus Functional Dysphagia	6.5% (6.3-6.7) 1.3% (1.2-1.4) 1.5% (1.4-1.6) 0.9% (0.9-1.0) 0.8% (0.7-0.9) 3.5% (3.3-3.7)	13.1% (11.9-14.4) 3.7% (3.0-4.4) 2.0% (1.5-2.5) 3.2% (2.6-3.9) 1.1% (0.8-1.6) 8.6% (7.6-9.7)	2.16 (1.93, 2.42) 2.91 (2.35, 3.58) 1.34 (1.01, 1.74) 3.49 (2.77, 4.36) 1.42 (0.97, 2.00) 2.58 (2.24, 2.96)	1.62 (1.41, 1.85) 2.13 (1.66, 2.71) 0.96 (0.70, 1.28) 2.45 (1.85, 3.20) 0.99 (0.63, 1.49) 1.98 (1.68, 2.33)
Gastroduodenal DGBI Functional Dyspepsia Postprandial Distress Syndrome Epigastric Pain Syndrome Excessive Belching Chronic nausea and vomiting Cyclic vomiting Rumination syndrome	11.7% (11.5-12.0) 8.1% (7.9-8.3) 6.8% (6.6-7.0) 2.9% (2.7-3.0) 1.1% (1.0-1.2) 1.1% (1.0-1.2) 1.4% (1.3-1.5) 3.0% (2.8-3.1)	20.8% (19.3-22.3) 15.0% (13.7-16.3) 12.5% (11.3-13.8) 7.5% (6.5-8.5) 2.9% (2.3-3.6) 2.1% (1.6-2.7) 3.7% (3.1-4.5) 5.5% (4.7-6.4)	1.97 (1.79, 2.17) 2.00 (1.80, 2.23) 1.96 (1.75, 2.20) 2.73 (2.35, 3.16) 2.62 (2.06, 3.30) 1.99 (1.51, 2.57) 2.81 (2.27, 3.44) 1.88 (1.59, 2.22)	1.88 (1.67, 2.10) 1.94 (1.70, 2.20) 1.88 (1.64, 2.16) 2.42 (2.02, 2.88) 2.13 (1.63, 2.76) 1.84 (1.35, 2.47) 2.70 (2.10, 3.44) 1.41 (1.16, 1.69)
Bowel DGBI Irritable bowel syndrome Functional Constipation Functional Diarrhea Functional Bloating Unspecified functional bowel disorder Opioid-induced constipation	35.3% (34.9-35.7) 4.6% (4.4-4.7) 12.4% (12.1-12.7) 4.8% (4.6-5.0) 3.2% (3.1-3.4) 9.3% (9.0-9.5) 1.7% (1.6-1.9)	48.2% (46.4-50.1) 9.8% (8.8-11.0) 12.1% (10.9-13.4) 10.3% (9.2-11.5) 3.9% (3.2-4.7) 10.4% (9.3-11.6) 3.3% (2.7-4.0)	1.70 (1.58, 1.84) 2.29 (2.00, 2.60) 0.97 (0.87, 1.09) 2.28 (2.00, 2.58) 1.23 (1.01, 1.49) 1.13 (1.00, 1.28) 1.92 (1.53, 2.36)	1.43 (1.31, 1.56) 2.01 (1.71, 2.35) 0.89 (0.78, 1.01) 1.95 (1.69, 2.24) 0.93 (0.75, 1.15) 1.06 (0.92, 1.21) 1.40 (1.09, 1.76)
Anorectal DGBI Fecal incontinence Levator Ani syndrome Proctalgia Fugax	8.3% (8.1-8.6) 1.7% (1.6-1.8) 1.3% (1.2-1.4) 6.0% (5.8-6.2)	17.8% (16.4-19.2) 7.5% (6.6-8.6) 2.9% (2.3-3.6) 11.4% (10.2-12.6)	2.38 (2.15, 2.63) 4.77 (4.08, 5.55) 2.31 (1.82, 2.89) 2.02 (1.79, 2.28)	1.88 (1.67, 2.11) 2.94 (2.45, 3.52) 1.94 (1.49, 2.51) 1.66 (1.44, 1.90)

Conclusion

This study found substantial regional variation in cholecystectomy rates, and an association with symptoms compatible with various DGBI in individuals with a history of cholecystectomy. While some symptoms may have contributed to unnecessary surgery, others are likely due to post-surgical intestinal maladaptation.

References

1. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

Gastroparesis, dyspepsia, and beyond (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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MYELOID MAS REGULATES PKM2-MEDIATED SPI1 LACTYLATION TO PROGRAM THE METABOLIC-INFLAMMATORY SENESCENCE AXIS OF MONONUCLEAR PHAGOCYTE SYSTEM DURING THE METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE (MASLD)

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