Impact of Cholecystectomy on Clinical Course of IBD: Increased Diarrhea, Healthcare Charges, Narcotic Use and Decreased Quality of Life Independent of Inflammation Status

Introduction: Cholecystectomy (CCY) for the treatment and/or prevention of gallbladder disease is one of the most commonly performed surgeries in the U.S. Among the 20 million Americans with gallstones, an estimated 300,000 undergo CCY annually. There is an association between gallstone disease and inflammatory bowel disease (IBD). However CCY alters biliary physiology and can predispose to bile acid diarrhea, potentially worsening the clinical course of IBD. At present, there is limited data on the rates of CCY in patients with IBD and the impact of CCY on disease course. Methods: This was an observational study from a consented, prospective, IBD natural history registry maintained at a tertiary center. Patients with IBD (Crohn's Disease (CD); Ulcerative Colitis (UC)) from 2009 to 2017 were analyzed. CCY status was determined by review of abdominal CT imaging. Quality of life was measured with SIBDQ during clinic encounters. Cumulative healthcare charges were curated over the observation time period. CRP and ESR functioned as biochemical markers of inflammation. Results: There were 1216 IBD patients (71% CD (n=866); 29% UC (n=350)) of whom 16% (n=194) had undergone CCY. CCY IBD patients had lower quality of life (mean SIBDQ score 42.9 vs. 49.7, p<0.001). CCY patients also had increased diarrhea episodes (p<0.001) compared with no CCY IBD but this was only true for CD and not for UC. CCY IBD had more frequent abdominal pain but no difference in CRP and ESR compared to the no CCY IBD. CCY patients had increased annual healthcare charges compared with no CCY IBD (median of $27,984.61 compared with $15,889.16 (p<0.001)). Median albumin level was lower in the CCY IBD group. The CCY IBD group had significantly higher use of narcotics as well as bile acid sequestrants. There was no difference in dysplasia between the two groups.586 Figure 1 No Caption available.Conclusion: IBD patients with CCY have significantly worse quality of life, worse diarrhea and increased healthcare charges compared to IBD patients who have not had this procedure. This was independent of inflammation status. Symptomatic therapy with bile acid sequestrants was used in only half of these individuals while narcotics were required in two thirds of the CCY IBD patients. These data suggest that CCY is an important clinical parameter which contributes to GI symptoms and worse clinical status in IBD. Given this potential for clinical deterioration, the decision to perform CCY in an IBD patient requires careful consideration.