Impact of gastrectomy on the risk of alcohol-associated liver disease in patients with gastric cancer

Gastrectomy may induce physiological changes that increase susceptibility to alcohol-associated liver disease, even with low alcohol intake. This cohort study investigated the association between gastrectomy, alcohol consumption, and liver-related disease incidence using the Korean National Health Insurance Service database. We analyzed 57,893 patients diagnosed with gastric cancer between 2002 and 2015 who underwent either endoscopic resection ( n = 22,078) or gastrectomy ( n = 35,815). Over a median follow-up of 6.9 years, the gastrectomy group exhibited a significantly higher, dose-dependent risk of alcoholic liver disease (ALD; ICD-10 code K70), a major component of the alcohol-associated liver disease spectrum, compared to the endoscopic resection group (mild intake: adjusted hazard ratio aHR 1.58, 95% CI 1.26–1.97; moderate-to-severe: aHR 1.61, 95% CI 1.22–2.12). Similarly, the risk of cirrhosis was significantly elevated in the gastrectomy group with moderate-to-severe alcohol intake (aHR 1.93, 95% CI 1.11–3.38), while no significant differences were observed in hepatocellular carcinoma incidence. These findings demonstrate that gastrectomy is associated with a heightened risk of ALD, even at low levels of alcohol consumption. Our findings suggest that careful monitoring of alcohol consumption and appropriate counseling may be warranted in patients following gastrectomy.