title: Does surgical removal of mucosal associated lymphoid tissue protect against adult coeliac disease? A case controlled study.
abstract: OBJECTIVE
  Surgical resection of mucosa associated lymphoid tissue has been suggested as a protective mechanism against the development of inflammatory bowel disease. Mucosal T-cell activity plays a pivotal role in coeliac disease pathogenesis. We aimed to determine if the development of adult coeliac disease is influenced by appendectomy or tonsillectomy.
  
  
  METHODS
  Three hundred patients over 16 years of age with biopsy proven coeliac disease were identified from two hospital databases in South Yorkshire. From these databases, appendectomy and tonsillectomy status was determined and compared with 1033 coeliac disease antibody-negative controls (volunteers recruited from general practice). Logistic regression was performed to correct for the age differences between the two groups; cross-table analysis was performed.
  
  
  RESULTS
  Thirteen percent of coeliac disease patients and 12.2% of controls had previous appendectomy (P = 0.71; odds ratio 1.08; 95% confidence interval 0.72-1.62). 20.7% of coeliac disease patients and 24.5% of the controls had previous tonsillectomy (P = 0.17; odds ratio 0.80; 95% confidence interval 0.59-1.10).
  
  
  CONCLUSIONS
  No significance was demonstrated in either the appendectomy or tonsillectomy group. Surgical removal of mucosal associated lymphoid tissue does not appear to prevent the development of adult onset coeliac disease.
authors.affiliation: Medical & Surgical Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: I A F
authors.initials: IA
authors.lastname: Azmy
authors.forename: D P
authors.initials: DP
authors.lastname: Hurlstone
authors.forename: T F
authors.initials: TF
authors.lastname: Butt
authors.forename: F
authors.initials: F
authors.lastname: Nasseri
authors.forename: D W
authors.initials: DW
authors.lastname: Bullimore
authors.forename: D S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000517:prevention & control*; D016015:Logistic Models; D008221:Lymphoid Tissue / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D014068:Tonsillectomy