Appendectomy does not decrease colectomy risk in ulcerative colitis

Last Updated: 2016-04-28

By Will Boggs MD

NEW YORK (Reuters Health) - Appendectomy does not decrease, and may increase, the risk of colectomy in patients with ulcerative colitis (UC), according to a retrospective study and meta-analysis.

"Appendectomy does not appear to be an effective treatment for ulcerative colitis," Dr. Alyssa Parian from Johns Hopkins School of Medicine, Baltimore, told Reuters Health by email.

"This is not to say that if true appendicitis develops, they shouldn't have their appendix removed; however, they shouldn't have a healthy appendix removed simply for the treatment of UC," she said.

Previous studies have shown that early appendectomy is associated with a decreased risk and delayed onset of UC, but there is conflicting evidence as to whether appendectomy influences the disease severity or need for total colectomy in patients with UC.

Dr. Parian's team used data from the National Institute of Diabetes and Digestive and Kidney Diseases Inflammatory Bowel Disease Genetics Consortium to evaluate whether appendectomy is associated with severe UC, as defined by the need for colectomy, and performed an updated systematic review and meta-analysis to investigate that possible association.

In their retrospective study, appendectomy performed at any time was associated with a 65% increased risk of colectomy (p=0.03), and a multivariable analysis confirmed the independent influence of appendectomy (odds ratio, 1.87; p=0.02).

There was no association between appendectomy before age 20 years and the risk of colectomy, according to the April 13 online report in Gut. However, appendectomy after the diagnosis of UC was associated with a 2.22-fold increased risk of colectomy.

Extensive disease, one or more extraintestinal manifestations, and former but not current smoking were also independent risk factors for colectomy.

An updated review and meta-analysis of seven studies (including the current study) found no significantly decreased or increased risk of colectomy among patients who underwent appendectomy, regardless of whether the appendectomy preceded or followed the diagnosis of UC.

"There is a prospective clinical trial under way to further investigate the role of appendectomy in UC patients," Dr. Parian said. "We look forward to seeing these results."

The authors reported no funding. One coauthor reported disclosures.

SOURCE: http://bit.ly/1WV5ASo

Gut 2016.