Abstract
Tonsillectomy is a commonly performed surgical procedure worldwide; however, the possible long-term consequences have not been fully explored. The tonsils are secondary lymphoid tissue providing a defensive barrier against pathogens. There are few data in the literature on the relationship between prior tonsillectomy and the risk of irritable bowel syndrome (IBS). The aim of this study was to evaluate the risk of developing IBS in patients who underwent tonsillectomy using a nationwide longitudinal population-based cohort. We identified 1300 patients with tonsillectomy and 2600 matched controls from the Longitudinal Health Insurance Research Database of the National Health Insurance Research Database in Taiwan. Propensity score analysis was used for matching age, gender, comorbidities, medications, and index year at a ratio of 1:2. Multiple Cox regression analysis was used to estimate the adjusted hazard ratio of IBS. Furthermore, sensitivity tests and a stratified analysis were conducted. The incidence of IBS was 3 per 1,000 person-years in tonsillectomy patients, which was higher than the rate of 1.8 per 1,000 person-years found in non-tonsillectomy patients. After adjustment for patients' age, gender, comorbidities, and medications, patients who underwent tonsillectomy had a 1.84-fold risk of developing IBS compared to those without tonsillectomy (adjusted hazard ratio [HR]:1.84; 95% CI, 1.09-3.09). Stratified analysis revealed that a higher adjusted HR of 3.79 (95% CI, 1.35-10.64) in patients ≥50 years old, and there was a marginally significantly higher adjusted HR of 1.98 (95% CI, 0.99-3.95) of developing IBS when the follow-up period was longer than 3 years. Tonsillectomy was associated with a higher risk of developing IBS. Physicians should provide appropriate monitoring of IBS in patients undergoing tonsillectomy.
Highlights
Tonsillectomy is one of the most frequently performed surgical interventions worldwide
After excluding patients diagnosed with irritable bowel syndrome (IBS) before tonsillectomy, there were 6,985 non-tonsillectomy and 1,306 tonsillectomy patients
A total of 59 cases of IBS were identified over 27,005 observed person-years, and 27 of these cases were associated with tonsillectomy
Summary
Tonsillectomy is one of the most frequently performed surgical interventions worldwide. Studies have shown that the tonsils are important part of the immune system, playing special roles in pathogen detection and defense. The tonsils form a Waldeyer’s ring around the apex of the respiratory and alimentary tracts, providing an early warning of airborne or ingested pathogens/antigens. Previous studies have found a dramatic decline in pre-existing antigen-specific IgA antibodies in the nasopharynx after tonsillectomy [3], suggesting that the tonsils are critical for generating mucosal immunity. Studies have examined the association between antecedent removal of tonsils and the risk of respiratory disorders [5], infectious diseases [5], asthma [5], premature acute myocardial infarction [6], autoimmune diseases [7], inflammatory bowel disease [8, 9], and cancers [10]. The absence of tonsils might have a lasting impact on human health
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