Cholecystectomy among patients with irritable bowel syndrome: a systematic review and meta-analysis

Background Irritable bowel syndrome (IBS) and gallbladder disease share overlapping symptoms that may contribute to diagnostic uncertainty and unnecessary cholecystectomy. This systematic review and meta-analysis evaluated whether patients with IBS are more likely to undergo cholecystectomy than those without IBS. Methods A systematic search of PubMed, Embase, Web of Science, and Google Scholar was conducted through June 3, 2026. Observational studies comparing cholecystectomy among adults with and without IBS were included. Random-effects meta-analysis was performed to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses, sensitivity analyses, influence diagnostics, meta-regression, publication bias assessment, and risk-of-bias evaluation were conducted. Results Ten studies met the inclusion criteria for the systematic review, and nine studies comprising 181,848 participants and 6,249 cholecystectomy events were included in the meta-analysis. Patients with IBS had significantly higher odds of undergoing cholecystectomy than controls (OR = 2.57, 95% CI 1.36–4.85; p = 0.009). Between-study heterogeneity was substantial (I 2 = 98.1%), but the association remained robust across leave-one-out sensitivity analyses. Subgroup analyses and meta-regression demonstrated that study design, geographic region, IBS diagnostic criteria, study quality, and sample size did not significantly influence the pooled effect estimate. No evidence of publication bias was detected, and the included studies were generally of good methodological quality. Conclusions Patients with IBS have significantly higher odds of undergoing cholecystectomy than individuals without IBS. These findings support careful evaluation of biliary symptoms in patients with IBS to improve diagnostic accuracy, optimize patient selection for surgery, and reduce unnecessary cholecystectomy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261412571 , identifier CRD420261412571.