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The risk of developing Crohn’s disease after an appendectomy: a population-based cohort study in Sweden and Denmark
  1. Gilaad G Kaplan1,
  2. Bo V Pedersen2,
  3. Roland E Andersson3,
  4. Bruce E Sands1,
  5. Joshua Korzenik1,
  6. Morten Frisch2
  1. 1MGH Crohn’s and Colitis Center and Gastrointestinal Unit, Massachusetts General Hospital and Harvard University, Boston, Massachusetts, USA
  2. 2Department of Epidemiology Research, Division of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
  3. 3Department of Surgery, County Hospital Ryhov, Jönköping, and Department of Surgery, University Hospital, Linköping, Sweden
  1. Correspondence to:
    Dr Morten Frisch
    Department of Epidemiology Research, Division of Epidemiology, Statens Serum Institut, Copenhagen, Denmark; mfr{at}ssi.dk

Abstract

Background: The relationship between appendectomy and Crohn’s disease is controversial. A Swedish–Danish cohort study was conducted to assess the risk of developing Crohn’s disease after an appendectomy.

Methods: 709 353 appendectomy patients in Sweden (since 1964) and Denmark (since 1977) were followed for first hospitalisations for Crohn’s disease to 2004. Standardised incidence ratios (SIR) served as relative risks.

Results: Overall, 1655 Crohn’s disease cases were observed during 11.1 million person-years of follow-up. Whereas appendectomy before the age of 10 years was not associated with the risk of Crohn’s disease (SIR 1.00; 95% CI 0.80–1.25), the overall SIR of developing Crohn’s disease was 1.52 (95% CI 1.45–1.59), being highest in the first 6 months (SIR 8.69; 95% CI 7.68–9.84). SIR diminished rapidly thereafter, with the risk of Crohn’s disease reaching background levels after 5–10 years for Crohn’s disease overall, as well as for Crohn’s ileitis, ileocolonic Crohn’s disease, Crohn’s colitis and other/unspecified Crohn’s disease. A long-term increased risk of Crohn’s disease up to 20 years after the appendectomy was seen only in appendectomy patients without appendicitis or mesenteric lymphadenitis.

Conclusion: The transient increased risk of Crohn’s disease after an appendectomy is probably explained by diagnostic bias.

  • ICD, International Classification of Diseases
  • SIR, standardized incidence ratio

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Footnotes

  • Published Online First 9 May 2007

  • Funding: This study was supported by unrestricted research grants from Aase and Ejnar Danielsen’s Foundation, Civil engineer Frode V Nyegaard and Wife’s Foundation, and the Gangsted Foundation.

  • Conflict of interest: None declared.

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