Cholecystectomy Tied To Worse Outcomes, QOL In Crohn

Crohn disease (CD) patients who undergo cholecystectomy (CCY) are at high risk for complications and decreased quality of life, new findings show.

"Our study design allowed us to follow CD patients for up to 9 years, and we found that CCY poses higher risk for chronic abdominal pain, more diarrheal events, and more hospital admissions among patients with CD, undermining their quality of life and validating the fact that CD patients represent a high-risk group for postcholecystectomy complications," Dr. David G. Binion of the University of Pittsburgh School of Medicine, in Pennsylvania, and colleagues write.

CCY can have adverse effects, such as postcholecystectomy syndrome, and is also associated with increased colorectal cancer risk, Dr. Binion and his team note in Inflammatory Bowel Diseases. CD patients are more likely to have gallstone disease and to undergo CCY, they add.

They reviewed data from the University of Pittsburgh Medical Center (UPMC) IBD registry for 834 CD patients, including 151 (18%) who had CCY.

Median Harvey-Bradley Index score, a measure of disease activity, was 6.2 for the CCY group vs 3.8 for the non-CCY group (P<0.001). Median Short Inflammatory Bowel Disease Questionnaire scores were 42.6 for the patients who underwent CCY, compared to 49.8 for those who did not (P<0.001), indicating worse disease-related quality of life.

After the authors controlled for age, gender, tobacco use and BMI, CCY was associated with significantly more frequent hospital admissions, more frequent diarrhea and worse abdominal pain. CCY was also associated with non-significant trends toward increased dysplasia and narcotics use.

A subgroup analysis of the 654 patients with ileal disease found similar results, although their risk of dysplasia was higher (adjusted odds ratio, 3.54; P=0.031).

"Future studies that determine and validate the impact of CCY in patients with CD, particularly those with terminal ileal involvement, and assess the risk to benefit ratio of CCY in specific clinical settings are warranted," the authors conclude.

Dr. Binion was not available for an interview by press time.

—Reuters Staff

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