336 Inflamm Bowel Dis • Volume 27, Number 3, March 2021 Author Contribution: FK contributed to the study design, statistical analysis, data interpretation, and drafting and revising the manuscript. ML contributed to the study design, statistical analysis, data interpretation, and revising the manuscript. MA contributed to the statistical analysis, interpretation of data, and revising the manuscript. CRR contributed to the analysis and interpretation of data. MS, JGH, and MD contributed to the acquisition of data and revising the manuscript. DB and GT contributed technical support and provided resources. TN contributed to the interpretation of data. AK contributed to revising the manuscript. DGB contributed to the administration, study design, acquisition of data, obtaining funding, study su- pervision, data interpretation, revising the article, and final approval of the version. Supported by: DGB reports support from grant number W81XWH-17-1-0556 from the Department of Defense. MD reports support from grant number W81XWH-11-2-0133 from the Department of Defense. Conflicts of interest: DGB and MD reports the following disclosures: consulting for Janssen Biotech, AbbVie, and Merck; research support from Takeda, Shire, and AbbVie. No other personal, professional or financial conflict of interest was reported by the authors. Address correspondence to: David Binion, Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street Mezzanine Level C Wing, Pittsburgh, PA 15213, USA. E-mail: binion@pitt.edu. #These authors share first-authorship status. © The Author(s) 2020. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com ORIGINAL RESEARCH ARTICLE—CLINICAL The Impact of Cholecystectomy on Long-Term Disease Outcomes and Quality of Life in Patients with Crohn’s Disease Filippos Koutroumpakis, MD, #, * , Maham Lodhi, MD, #,† , Maaz Ahsan,* Claudia Ramos Rivers, MD,* Marc Schwartz, MD,* Jana G. Hashash, MD MSc,* Dmitriy Babichenko, PhD, ‡ Gong Tang, PhD, § Tanvi Nagpal,* Michael Dunn, MD,* Ali Keshavarzian, MD, † and David G. Binion, MD* Background: Cholecystectomy (CCY) is one of the most frequently performed abdominal surgeries. However, the impact of CCY in clinical settings with altered gastrointestinal physiology and anatomy, such as Crohn’s disease (CD), has not been fully characterized. We sought to inves- tigate clinical outcomes, disease severity, and quality of life of CD patients after CCY. Methods: We utilized a prospective, longitudinal registry of consented CD patients followed at a tertiary center. Crohn’s disease patients that had or had not undergone CCY formed the 2 study groups. The absence or presence of gallbladder was confirmed with abdominal CT scans obtained during routine care. Multiyear clinical, biochemical, and histologic data were collected and analyzed. Results: Among 834 CD patients, 151 (18%) had undergone CCY. History of CCY was associated with higher disease activity (median Harvey- Bradshaw index; P < 0.001), more years with anemia (P = 0.048), lower albumin (P = 0.001), worse quality of life (mean Short Inflammatory Bowel Disease Questionnaire; P < 0.001), chronic abdominal pain (P < 0.001), higher risk for incident colonic dysplasia (P = 0.011), higher rates of annual hospital admissions (P = 0.004), and opioid use (P < 0.001). In multivariate analysis, CCY remained associated with higher disease activity (P < 0.001), lower albumin (P = 0.008), lower quality of life (P < 0.001), and more hospital admissions (P = 0.008), whereas CD patients with diseased ileum had higher risk for colonic dysplasia (P = 0.031). Conclusions: CCY in CD patients was associated with multiple markers of disease activity and worse quality of life during multiyear follow up. This data suggests that CCY in CD patients may adversely impact the long-term clinical course. Key Words: dysplasia, quality of life, surgery, irritable bowel syndrome, abdominal pain, bile acid malabsorption, big data, inflammatory bowel disease INTRODUCTION From the surgical origins of open cholecystectomy ini- tially performed 122 years ago to its newer laparoscopic itera- tion first performed 35 years ago, cholecystectomy (CCY) has emerged as one of the most frequently performed abdominal surgeries. 1 In the United States, more than 1.2 million CCYs are done annually, with 90% of these procedures performed laparoscopically. 2 This surgery is usually performed for gall- stone disease, but the indications vary from practice to prac- tice. In some occasions, it is performed prophylactically or for diagnostic purposes. Gallbladder removal is generally considered a safe and routine procedure but can be associated with rare, severe com- plications in the perioperative time period. Long-term com- plications of CCY are well known, often associated with persistent abdominal pain, dyspepsia, and diarrhea, collec- tively known as postcholecystectomy syndrome, which can present from hours to years after the surgery. 3 Furthermore, multiple studies have suggested that CCY leads to increased risk for colorectal cancer in the general population. 4, 5 The pro- posed mechanism suggests that gallbladder removal will dis- rupt the coordinated storage and triggered secretion of bile in the presence of food/digestate in the intestine. After gall- bladder removal, there is relaxation of the sphincter of Oddi and continuous drainage of bile into the gastrointestinal (GI) doi: 10.1093/ibd/izaa076 Published online 20 April 2020 Received for publications January 8, 2020; Editorial Decision March 24, 2020. From the *Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; † Department of Medicine, Division of Gastroenterology and Hepatology, Rush University Medical Center, Illinois, USA; ‡ School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; § School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA Downloaded from https://academic.oup.com/ibdjournal/article/27/3/336/5822893 by guest on 30 September 2022