Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy – a cohort study
Background and objective Appendectomy may modulate the risk of inflammatory bowel disease through an effect on the gut microbiota. This study investigated the associations between appendectomy and incidence of Crohn’s disease (CD) or ulcerative colitis (UC), with an emphasis on the influence of age...
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BMJ Publishing Group
2022-11-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/9/1/e000925.full |
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| author | Marie-Elise Parent Canisius Fantodji Prevost Jantchou Marie-Claude Rousseau |
| author_facet | Marie-Elise Parent Canisius Fantodji Prevost Jantchou Marie-Claude Rousseau |
| author_sort | Marie-Elise Parent |
| collection | DOAJ |
| description | Background and objective Appendectomy may modulate the risk of inflammatory bowel disease through an effect on the gut microbiota. This study investigated the associations between appendectomy and incidence of Crohn’s disease (CD) or ulcerative colitis (UC), with an emphasis on the influence of age and time post appendectomy.Methods This cohort study included 400 520 subjects born in Québec in 1970–1974 and followed until 2014. Administrative health data were used to ascertain appendectomy and cases of CD and UC. Cox proportional hazards models with time-dependent variables (appendectomy and time elapsed post appendectomy) allowed for the estimation of HRs and 95% CIs.Results A total of 2545 (0.6%) CD cases and 1134 (0.3%) UC cases were identified during follow-up. Appendectomy increased the risk of CD (HR=2.02; 95% CI: 1.66 to 2.44), especially when performed at 18–29 years of age. The risk of CD was increased in the first 2 years, and decreased significantly after ≥15 years post appendectomy. Appendectomy appeared to protect against UC (HR=0.39; 95% CI: 0.22 to 0.71). The risk of UC was not associated with age at appendectomy, but decreased with time elapsed post appendectomy (HR=0.21; 95% CI: 0.06 to 0.72, comparing ≥5 with 0–4 years after appendectomy).Conclusions The increased risk of CD related to appendectomy in young adults may result from detection bias, but physicians should have a low threshold for suspicion of CD in young symptomatic adults with a history of appendectomy. A strong protective effect of appendectomy against UC was observed after 5 years. |
| format | Article |
| id | doaj-art-33bf5f5f4c304f05b691cee733bd0b54 |
| institution | DOAJ |
| issn | 2054-4774 |
| language | English |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-33bf5f5f4c304f05b691cee733bd0b542025-08-20T03:20:54ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742022-11-019110.1136/bmjgast-2022-000925Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy – a cohort studyMarie-Elise Parent0Canisius Fantodji1Prevost Jantchou2Marie-Claude Rousseau3Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Laval, Quebec, CanadaEpidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Laval, Quebec, CanadaCHU Sainte-Justine, Montreal, Québec, CanadaEpidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Laval, Quebec, CanadaBackground and objective Appendectomy may modulate the risk of inflammatory bowel disease through an effect on the gut microbiota. This study investigated the associations between appendectomy and incidence of Crohn’s disease (CD) or ulcerative colitis (UC), with an emphasis on the influence of age and time post appendectomy.Methods This cohort study included 400 520 subjects born in Québec in 1970–1974 and followed until 2014. Administrative health data were used to ascertain appendectomy and cases of CD and UC. Cox proportional hazards models with time-dependent variables (appendectomy and time elapsed post appendectomy) allowed for the estimation of HRs and 95% CIs.Results A total of 2545 (0.6%) CD cases and 1134 (0.3%) UC cases were identified during follow-up. Appendectomy increased the risk of CD (HR=2.02; 95% CI: 1.66 to 2.44), especially when performed at 18–29 years of age. The risk of CD was increased in the first 2 years, and decreased significantly after ≥15 years post appendectomy. Appendectomy appeared to protect against UC (HR=0.39; 95% CI: 0.22 to 0.71). The risk of UC was not associated with age at appendectomy, but decreased with time elapsed post appendectomy (HR=0.21; 95% CI: 0.06 to 0.72, comparing ≥5 with 0–4 years after appendectomy).Conclusions The increased risk of CD related to appendectomy in young adults may result from detection bias, but physicians should have a low threshold for suspicion of CD in young symptomatic adults with a history of appendectomy. A strong protective effect of appendectomy against UC was observed after 5 years.https://bmjopengastro.bmj.com/content/9/1/e000925.full |
| spellingShingle | Marie-Elise Parent Canisius Fantodji Prevost Jantchou Marie-Claude Rousseau Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy – a cohort study BMJ Open Gastroenterology |
| title | Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy – a cohort study |
| title_full | Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy – a cohort study |
| title_fullStr | Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy – a cohort study |
| title_full_unstemmed | Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy – a cohort study |
| title_short | Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy – a cohort study |
| title_sort | appendectomy and risk for inflammatory bowel disease effect of age and time post appendectomy a cohort study |
| url | https://bmjopengastro.bmj.com/content/9/1/e000925.full |
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