title: Worse clinical course of disease in Crohn's patients with previous appendectomy.
abstract: OBJECTIVE
  The aim of the present study was to assess the effect of previous appendectomy in a series of Crohn's disease (CD) patients on the clinical characteristics and course of disease.
  
  
  METHODS
  Demographic and clinical data were retrospectively analysed for 129 consecutive outpatients (68 men and 61 women, median age 38 years) with CD. For each patient, information concerning appendectomy, indication for surgery (acute/chronic) and the date of surgery were recorded. The date of the appendectomy in relation to the date of CD diagnosis was carefully assessed in order to evaluate the precise relationship between the two events. A total of 129 CD patients who had not undergone previous appendectomy served as controls. The severity of disease was assessed retrospectively by evaluating the need for systemic steroids, immunosuppressants and surgical treatment for CD, particularly resective procedures.
  
  
  RESULTS
  Forty-one CD patients (31.8%) underwent appendectomy before the diagnosis of disease. Appendectomy before diagnosis showed a negative association with colonic disease localization and with articular manifestations. In addition, the 41 patients with previous appendectomy had a significantly greater risk of surgery, particularly resective. Multivariate analysis confirmed appendectomy performed before diagnosis as an independent risk factor for surgery; on the contrary, colonic site and inflammatory type of disease were independent factors protecting against surgery. Although current smokers were at an increased risk of surgical treatment, a smoking habit alone did not seem to be relevant at the multivariate analysis.
  
  
  CONCLUSIONS
  The results of this study indicate a worse clinical course of CD in patients appendicectomized before diagnosis.
authors.affiliation: Medical-Surgical Department of Clinical and Experimental Medicine 'F. Magrassi - A. Lanzara', Second University of Naples, Naples, Italy. gabriele.riegler@unina2.it
authors.forename: Gabriele
authors.initials: G
authors.lastname: Riegler
authors.forename: Luigi
authors.initials: L
authors.lastname: Caserta
authors.forename: Ilaria
authors.initials: I
authors.lastname: Esposito
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: De Filippo
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bossa
authors.forename: Pasquale
authors.initials: P
authors.lastname: Esposito
authors.forename: Maria Itria
authors.initials: MI
authors.lastname: Russo
authors.forename: Romano
authors.initials: R
authors.lastname: Carratù
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects