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Appendectomy and the risk of microscopic colitis - A systematic review and meta-analysis
Zhao Xu Tian1, Hong Ying Tang2, Yan Ri Duan2
1Gastroenterology, The Third People's Hospital of Yuhang District, .
Background:
microscopic colitis (MC), a chronic intestinal inflammatory disorder characterised by persistent watery diarrhoea, is categorised into collagenous and lymphocytic subtypes. Recent studies suggest that appendectomy influences the risk of MC, although the evidence remains inconclusive. This meta-analysis of available research was conducted to clarify the relationship between appendectomy and MC risk.
Methods:
in accordance with the PRISMA guidelines, a comprehensive search was conducted in the Web of Science, EMBASE, and PubMed up to January 2024, focusing on studies that explored the association between appendectomy and MC. Quality was assessed using the Newcastle-Ottawa Scale, with data synthesis using the DerSimonian and Laird random-effects model. Heterogeneity and potential biases were evaluated; subgroup analyses were performed to investigate specific associations.
Results:
six studies were analysed, including one cohort and five case-control studies involving 85,845 participants. The combined analysis showed no significant link between appendectomy and MC risk (OR: 1.20, 95 % CI: 0.91-1.58), despite moderate heterogeneity (I² = 59 %). Subgroup analyses indicated potential associations in specific contexts. Notably, significant associations were found in subgroups based on MC subtypes (CC: OR 1.59, 95 % CI: 1.20-2.10; LC: OR 1.45, 95 % CI: 1.34-1.58), unadjusted ORs (OR 1.42, 95 % CI: 1.17-1.73), healthy control groups (OR 1.51, 95 % CI: 1.38-1.67) and studies using medical records for appendectomy history (OR 1.50, 95 % CI: 1.28-1.75). Other subgroup analyses did not yield significant results.
Conclusion:
this meta-analysis did not support a significant association between appendectomy and increased risk of MC. These findings highlight the need for further large-scale, prospective studies to explore this relationship in greater detail, considering the potential for nuanced interactions and the impacts of various confounding factors.
Insights
This meta-analysis found no overall link between appendectomy and microscopic colitis (MC) risk. However, specific subgroup analyses suggest a potential association with MC subtypes and certain study designs.
Area of Science:
- Gastroenterology
- Epidemiology
- Surgical Outcomes
Background:
- Microscopic colitis (MC) is a chronic inflammatory bowel disorder causing watery diarrhea.
- Existing research on appendectomy's influence on MC risk is inconclusive.
- This study aims to clarify the relationship between appendectomy and MC risk.
Purpose of the Study:
- To conduct a meta-analysis to determine the association between appendectomy and the risk of microscopic colitis.
- To synthesize evidence from existing studies to provide a clearer understanding of this relationship.
Main Methods:
- A systematic literature search was performed across PubMed, EMBASE, and Web of Science up to January 2024.
- Six studies (one cohort, five case-control) involving 85,845 participants were included.
- Data were synthesized using a random-effects model, with quality assessed by the Newcastle-Ottawa Scale.
Main Results:
- The overall meta-analysis revealed no significant association between appendectomy and MC risk (OR: 1.20, 95% CI: 0.91-1.58).
- Moderate heterogeneity was observed (I² = 59%).
- Significant associations emerged in subgroup analyses for collagenous colitis (CC), lymphocytic colitis (LC), unadjusted odds ratios, healthy control groups, and studies using medical records.
Conclusions:
- The current meta-analysis does not support a significant link between appendectomy and an increased risk of microscopic colitis.
- Further large-scale, prospective research is warranted to investigate potential nuanced interactions and confounding factors.
- Subgroup findings suggest a need for more detailed investigation into specific MC subtypes and study methodologies.
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