Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 28, 2006; 12(8): 1235-1242
Published online Feb 28, 2006. doi: 10.3748/wjg.v12.i8.1235
Prior appendectomy and the phenotype and course of Crohn’s disease
Jacques Cosnes, Philippe Seksik, Isabelle Nion-Larmurier, Laurent Beaugerie, Jean-Pierre Gendre
Jacques Cosnes, Philippe Seksik, Isabelle Nion-Larmurier, Laurent Beaugerie, Jean-Pierre Gendre, Service de Gastroentérologie et Nutrition, hôpital St-Antoine, Paris, France
Author contributions: All authors contributed equally to the work.
Correspondence to: Professor J Cosnes, Service de Gastroentérologie et Nutrition, hôpital St-Antoine, 184 rue du Faubourg St-Antoine, 75571 Paris cedex 12, France.
Telephone: +33-1-49283170 Fax: +33-1-49283188
Received: July 23, 2005
Revised: October 15, 2005
Accepted: October 26, 2005
Published online: February 28, 2006

AIM: To determine whether prior appendectomy modifies the phenotype and severity of Crohn’s disease.

METHODS: Appendectomy status and smoking habits were specified by direct interview in 2838 patients consecutively seen between 1995 and 2004. Occurrence of complications and therapeutic needs were reviewed retrospectively. Additionally, annual disease activity was assessed prospectively between 1995 and 2004 in patients who had not had ileocecal resection and of a matched control group.

RESULTS: Compared to 1770 non-appendectomized patients, appendectomized patients more than 5 years before Crohn’s disease diagnosis (n=716) were more often females, smokers, with ileal disease. Cox regression showed that prior appendectomy was positively related to the risk of intestinal stricture (adjusted hazard ratio, 1.24; 95% confidence interval, 1.13 to 1.36; P = 0.02) and inversely related to the risk of perianal fistulization (adjusted hazard ratio, 0.75; 95% confidence interval, 0.68 to 0.83; P = 0.002). No difference was observed between the two groups regarding the therapeutic needs, except for an increased risk of surgery in appendectomized patients, attributable to the increased prevalence of ileal disease. Between 1995 and 2004, Crohn’s disease was active during 50% of years in appendectomized patients (1 318 out of 2 637 patient-years) and 51% in non-appendectomized patients (1 454 out of 2 841 patient-years; NS).

CONCLUSION: Prior appendectomy is associated with a more proximal disease and has an increased risk of stricture and a lesser risk of anal fistulization. However, the severity of the disease is unaffected.

Keywords: Crohn’s disease, Appendectomy, Surgery, Smoking