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Appendectomy does not decrease the risk of future colectomy in UC: results from a large cohort and meta-analysis
  1. Alyssa Parian1,
  2. Berkeley Limketkai1,2,
  3. Joyce Koh1,
  4. Steven R Brant1,
  5. Alain Bitton3,
  6. Judy H Cho4,
  7. Richard H Duerr5,
  8. Dermot P McGovern6,
  9. Deborah D Proctor7,
  10. Miguel D Regueiro5,
  11. John D Rioux8,
  12. Phil Schumm9,
  13. Kent D Taylor6,
  14. Mark S Silverberg10,
  15. A Hillary Steinhart10,
  16. Ruben Hernaez1,
  17. Mark Lazarev1
  1. 1 Division of Gastroenterology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2 Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Stanford, California, USA
  3. 3 Division of Gastroenterology, McGill University, Montreal, Québec, Canada
  4. 4 Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA
  5. 5 Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6 Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  7. 7 Division of Digestive Disease, Yale School of Medicine, New Haven, Connecticut, USA
  8. 8 Division of Medicine, Université de Montréal, Montreal, Québec, Canada
  9. 9 Department of Health Studies, University of Chicago, Chicago, Illinois, USA
  10. 10 Division of Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Alyssa Parian, Division of Gastroenterology, Johns Hopkins School of Medicine, 4940 Eastern Avenue, Building A-502, Baltimore, MD 21224, USA; Aparian1{at}


Objectives Early appendectomy is inversely associated with the development of UC. However, the impact of appendectomy on the clinical course of UC is controversial, generally favouring a milder disease course. We aim to describe the effect appendectomy has on the disease course of UC with focus on the timing of appendectomy in relation to UC diagnosis.

Design Using the National Institute of Diabetes and Digestive and Kidney Diseases Inflammatory Bowel Disease Genetics Consortium database of patients with UC, the risk of colectomy was compared between patients who did and did not undergo appendectomy. In addition, we performed a meta-analysis of studies that examined the association between appendectomy and colectomy.

Results 2980 patients with UC were initially included. 111 (4.4%) patients with UC had an appendectomy; of which 63 were performed prior to UC diagnosis and 48 after diagnosis. In multivariable analysis, appendectomy performed at any time was an independent risk factor for colectomy (OR 1.9, 95% CI 1.1 to 3.1), with appendectomy performed after UC diagnosis most strongly associated with colectomy (OR 2.2, 95% CI 1.1 to 4.5). An updated meta-analysis showed appendectomy performed either prior to or after UC diagnosis had no effect on colectomy rates.

Conclusions Appendectomy performed at any time in relation to UC diagnosis was not associated with a decrease in severity of disease. In fact, appendectomy after UC diagnosis may be associated with a higher risk of colectomy. These findings question the proposed use of appendectomy as treatment for UC.


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