Background: Cholecystectomy is one of the most commonly performed surgical procedures worldwide, with a global prevalence of about 5%. A common side effect after cholecystectomy is post-cholecystectomy diarrhea, which can lead to bile acid diarrhea (BAD). BAD is a socially debilitating disease characterized by diarrhea, fecal urgency, and fecal incontinence. BAD is caused by excessive amounts of bile acids in the colon and is estimated to affect an estimated 1–2% of the population. Knowledge on the incidence of post-cholecystectomy BAD is lacking, and this nationwide cohort study investigated the incidence of BAD in individuals with and without a history of cholecystectomy. Materials and Methods: By using nationwide Danish health registries, individuals who had undergone a cholecystectomy were identified ( n = 148 834) and matched 1:10 to a reference population of age- and sex-matched individuals without cholecystectomy ( n = 1 487 914). BAD was defined as referral for a 75 selenium-homotaurocholic acid (SeHCAT) test followed by redemption of a bile acid sequestrant prescription within 365 days, or registration of a BAD diagnosis code. Results: A higher proportion of individuals with cholecystectomy were diagnosed with BAD compared to their matched controls (0.7% vs. 0.1%). Individuals who had undergone cholecystectomy had a higher cause-specific hazard of BAD (hazard ratio: 6.53, 95% confidence interval: 6.07–7.02) compared with matches. Conclusion: In this nationwide cohort study, individuals undergoing cholecystectomy had a seven-fold increased risk of developing BAD compared with an age- and sex-matched reference population, highlighting the importance of considering BAD as a potential comorbidity in individuals undergoing cholecystectomy.
Kårhus et al. (2026) studied this question.