Abstract
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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-026-40073-w.