Epidemiology

Appendectomy not linked to primary sclerosing cholangitis

Last Updated: 2004-07-07 14:50:18 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Contrary to what is seen with ulcerative colitis, appendectomy is not associated with the development of primary sclerosing cholangitis (PSC), according to a report published in the July issue of Gut. However, for both ulcerative colitis and PSC, appendectomy is tied to a delay in disease onset.

In agreement with previous research, the appendectomy rate for patients who developed ulcerative colitis was four times lower than that seen in matched controls (p = 0.0001). By contrast, a history of this surgical procedure did not seem to raise or lower the risk of PSC or affect disease severity in patients with concomitant inflammatory bowel disease (IBD).

To investigate the interaction between appendectomy and these diseases, Dr. T. H. J. Florin, from the University of Queensland in Brisbane, Australia, and colleagues analyzed data from 78 PSC-IBD patients, 12 pure PSC patients, 294 ulcerative colitis patients, and 1466 matched controls.

In all three patient groups, appendectomy was associated with a delay in disease onset of about 5 years, the researchers report. Moreover, this held true even after accounting for smoking status.

Prior appendectomy had no bearing on disease extent or severity in patients with PSC-IBD. In the ulcerative colitis group, by contrast, this surgery was linked to more extensive disease, but also with a reduced need for immunosuppression or colectomy (p = 0.004).

In the PSC-IBD and ulcerative colitis groups, appendectomy was tied to an increased risk of high-grade dysplasia or colorectal cancer, but the association fell short of statistical significance. However, in a meta-analysis combining data from the present and past studies, appendectomy raised the risk of colorectal cancer in ulcerative colitis patients by 15-fold (p = 0.004).

"Further prospective studies are required to characterize the influence of appendectomy on the extent of colitis in IBD and on the associated dysplasia or colorectal cancer," the investigators note.

Gut 2004;53:973-979.