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Prior Appendectomy Is Associated With a Milder Clinical Course in Crohn's Disease: A Nationwide Population-based
Anders Mark-Christensen1,2, Eskild Bendix Kristiansen1, Søren Laurberg3
1Department of Clinical Epidemiology, Aarhus University Hospital, Århus, Denmark.
Inflammatory Bowel Diseases
|April 2, 2024
Summary
Appendectomy appears to improve the clinical course of Crohn's disease (CD), leading to fewer hospital admissions and reduced need for biologics or surgery. This suggests a milder disease progression for CD patients who have had their appendix removed.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Inflammatory Bowel Disease Research
Background:
- The impact of appendectomy on Crohn's disease (CD) clinical course is debated due to limited and conflicting evidence.
- This study aimed to clarify the association between appendectomy and CD progression.
Purpose of the Study:
- To investigate the relationship between appendectomy and the clinical course of Crohn's disease (CD).
- To determine if appendectomy influences CD-related hospital admissions, biologic treatment initiation, and intestinal resections.
Main Methods:
- Utilized the Danish National Patient Registry to identify 21,189 CD patients from 1977-2017.
- Matched appendectomy patients with non-appendectomy CD controls, comparing outcomes using incidence rate ratios and Cox regression analysis.
- Analyzed rates of CD-related hospital admissions, biologic treatment initiation, and intestinal resections.
Main Results:
- CD patients with prior appendectomy showed significantly lower rates of CD-related hospital admissions (IRR 0.83-0.85).
- Appendectomy before CD diagnosis was associated with reduced initiation of biologics (aHR 0.47-0.61) and colorectal resections (aHR 0.63-0.94).
- Appendectomy after CD diagnosis did not significantly alter biologic use or intestinal resection rates.
Conclusions:
- Previous appendectomy is linked to a milder clinical course in Crohn's disease (CD).
- The findings suggest a potential protective effect of appendectomy on CD severity, particularly when performed before disease onset.
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