Abstract
Background and Aim The relationship between prior appendectomy and Crohn's disease (CD) has previously revealed conflicting findings. The present study investigates the relationship between prior appendectomy and CD development in Chinese patients. Methods A retrospective case-control study was performed to compare prior appendectomy rate between CD patients and age- and gender-matched controls at two Chinese hospitals. The clinical course of CD was determined in patients who underwent and did not undergo appendectomies before CD diagnosis. Results A total of 617 CD patients and 617 controls were included. The appendectomy rate before CD diagnosis in patients was higher, when compared to controls (6.65% versus 3.73%, P = 0.033). Appendectomy was a risk factor for the onset of CD independent of smoking in the multivariate analysis (OR: 1.878; 95% CI: 1.111–3.174; P = 0.019). Appendectomies were performed closer to the date of CD diagnosis in the trend test (P = 0.039). The rate of appendectomy within one year or 1-5 years before CD diagnosis was higher in patients when compared to that in controls (0.97% versus 0%, P = 0.031; 1.13% versus 0.32%, P = 0.180). However, the rate of appendectomy over five years before CD diagnosis was close to controls (4.54% versus 3.40%, P = 0.392). No significant differences in disease location, behavior, medication, and intestinal resection between appendectomy and nonappendectomy CD patients were found, even in the subgroup analysis by age of appendectomy. Conclusion Prior appendectomy is a risk factor for the onset of CD. However, the appendectomy rate only increased for a short duration before CD diagnosis, likely reflecting a diagnostic bias. Prior appendectomy did not influence the features or course of CD.
Highlights
Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gastrointestinal tract
In the excluded CD patients, two patients were not sure about whether an appendectomy was performed, while the other two patients did not know whether an appendectomy was performed with intestinal resection and were not sure about the date of CD diagnosis
The results revealed that appendectomy was not an independent risk factor for the application of immunosuppressants in the logistic regression analysis (OR: 1.676; 95% CI: 0.821–3.421; P = 0 156), but age of CD diagnosis was correlated to the application of immunosuppressants (OR: 1.014; 95% CI: 1.002–1.026; P = 0 024)
Summary
Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gastrointestinal tract. Two studies suggested that appendectomy before CD diagnosis was associated with worsened clinical course in patients [14, 24]. Data regarding the effect of appendectomy on CD onset and its clinical course in Chinese patients are scarce. The present study investigates the relationship between prior appendectomy and CD development in Chinese patients. A retrospective case-control study was performed to compare prior appendectomy rate between CD patients and ageand gender-matched controls at two Chinese hospitals. The appendectomy rate before CD diagnosis in patients was higher, when compared to controls (6.65% versus 3.73%, P = 0 033). The rate of appendectomy within one year or 1-5 years before CD diagnosis was higher in patients when compared to that in controls (0.97% versus 0%, P = 0 031; 1.13% versus 0.32%, P = 0 180). Prior appendectomy did not influence the features or course of CD
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