Prior appendectomy and the phenotype and course of Crohn’s disease

Abstract

AIM:To determine whether prior appendectomy modifies the phenotype and severity of Crohn's disease. METHODS:Appendectomy status and smoking habits were specified by direct interview in 2838 patients consecutively seen between 1995 and 2004. Occurrence of complications and therapeutic needs were reviewed retrospectively. Additionally, annual disease activity was assessed prospectively between 1995 and 2004 in patients who had not had ileocecal resection and of a matched control group. RESULTS:Compared to 1770 non-appendectomized patients, appendectomized patients more than 5 years before Crohn's disease diagnosis (n =716) were more often females, smokers, with ileal disease. Cox regression showed that prior appendectomy was positively related to the risk of intestinal stricture (adjusted hazard ratio, 1.24; 95% confidence interval, 1.13 to 1.36; P = 0.02) and inversely related to the risk of perianal fistulization (adjusted hazard ratio, 0.75; 95% confidence interval, 0.68 to 0.83; P = 0.002). No difference was observed between the two groups regarding the therapeutic needs, except for an increased risk of surgery in appendectomized patients, attributable to the increased prevalence of ileal disease. Between 1995 and 2004, Crohn's disease was active during 50% of years in appendectomized patients (1 318 out of 2 637 patientyears) and 51% in non-appendectomized patients (1 454 out of 2 841 patient-years; NS). CONCLUSION:Prior appendectomy is associated with a more proximal disease and has an increased risk of stricture and a lesser risk of anal fistulization. However, the severity of the disease is unaffected.

Impact of early thiopurines on surgery in 2770 children and young people diagnosed with inflammatory bowel disease: a national population-based study

“…In a study by Lakatos et al ., the effects of smoking appeared to be associated with a protective effect against the risk of surgery in adult UC but their findings failed to reach significance (HR 0.25, 95% CI: 0.06–1.06, P = 0.06). Our study also identifies appendectomy to be a powerful predictor of first surgery in CD (HR 7.90, 95% CI: 3.21–19.4), which adds to the body of evidence that it is an important associated risk factor although the biological significance is uncertain …”

Fibrogenesis in Crohn's Disease

“…Patient gender, the initial type of treatment, time from symptom onset to diagnosis, and the nature of the symptoms do not appear to influence the disease course (19). Recognized factors associated with the development of the fibrostenosing phenotype are listed in Table 2 (20,21).…”

Emerging trends and risk factors for perianal surgery in Crohn’s disease: a 20-year national population-based cohort study

“…We considered age at diagnosis, sex, current smoking status, history of appendectomy, history of previous intestinal surgery and early steroid use, within 3 months of diagnosis to be potential confounders that have been associated with a more severe course of disease and could therefore influence the risk of having PAS [23][24][25][26].…”