Prior appendectomy and the phenotype and course of Crohn's disease.
OBJECTIVE
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 (1318 out of 2637 patient-years) and 51% in non-appendectomized patients (1454 out of 2841 patient-years; NS).


CONCLUSIONS
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.
Service de Gastroentérologie et Nutrition, hôpital St-Antoine, 184 rue du Faubourg St-Antoine, 75571 Paris cedex 12, France. jacques.cosnes@sat.ap-hop-paris.fr
Jacques
J
Cosnes
Philippe
P
Seksik
Isabelle
I
Nion-Larmurier
Laurent
L
Beaugerie
Jean-Pierre
JP
Gendre
D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D003093:Colitis, Ulcerative / Q000473:pathology / Q000503:physiopathology; D003424:Crohn Disease / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010641:Phenotype; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking; D013997:Time Factors