Epidemiology of appendicectomy in primary sclerosing cholangitis and ulcerative colitis: Its influence on the clinical behaviour of these diseases

Florin, T. H. J., Pandeya, N. and Radford-Smith, G. L. (2004) Epidemiology of appendicectomy in primary sclerosing cholangitis and ulcerative colitis: Its influence on the clinical behaviour of these diseases. Gut, 53 7: 973-979. doi:10.1136/gut.2003.036483


Author Florin, T. H. J.
Pandeya, N.
Radford-Smith, G. L.
Title Epidemiology of appendicectomy in primary sclerosing cholangitis and ulcerative colitis: Its influence on the clinical behaviour of these diseases
Journal name Gut   Check publisher's open access policy
ISSN 0017-5749
1468-3288
Publication date 2004-07
Sub-type Article (original research)
DOI 10.1136/gut.2003.036483
Volume 53
Issue 7
Start page 973
End page 979
Total pages 7
Editor R. C. Spiller
Place of publication London, U.K.
Publisher BMJ Publishing Group
Collection year 2004
Language eng
Subject C1
321006 Gastroenterology and Hepatology
730113 Digestive system and disorders
730306 Evaluation of health outcomes
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
Formatted abstract
Background and aims
Appendicectomy and smoking are environmental factors that are known to influence ulcerative colitis (UC). The phenotype of UC is different in patients with coexistent primary sclerosing cholangitis (PSC). This study investigates the interaction of appendicectomy and PSC on the epidemiology and clinical behaviour of colitis.

Methods
Patients were from the Brisbane IBD Research Group database. Controls were from the Australian twin registry. Seventy eight PSC-inflammatory bowel disease (PSC-IBD) patients, 12 pure PSC, and 294 UC patients were matched with 1466 controls by sex and birth cohort that comprised randomly selected twins from each twin pair. The effects of appendicectomy, smoking, or PSC on the onset of disease, disease extent, disease severity (as identified by immunosuppression-colectomy or liver transplant), and disease related complications (high grade dysplasia, colorectal cancer, or cholangiocarcinoma) were investigated using univariate and multiple logistic regression analyses.

Results
PSC-IBD patients had a more extensive colitis than UC patients (p,0.0001) but required less immunosuppression (p = 0.007), which was independent of disease extent. They were more likely to have high grade dysplasia or colorectal cancer (p = 0.029) than UC patients. Appendicectomy rates in the PSC groups were not different from the control groups (p = 0.72, 0.76), which was in sharp contrast with UC where the rate was four times less (p = 0.0001). Prior appendicectomy appeared to be associated with an approximate five year delay in the onset of intestinal (PSC-IBD or UC) or hepatic (PSC) disease, which was independent of smoking. Appendicectomy did not independently alter the extent or severity of disease in PSC. In contrast, prior appendicectomy in UC was associated with more extensive disease but with a lesser requirement for immunosuppression or colectomy for the treatment of colitis (p = 0.004). There were trends for high grade dysplasia or colorectal cancer with appendicectomy in both PSC-IBD and UC. Although these trends were not statistically significant, colorectal cancer appeared more frequent with appendicectomy in a meta-analysis of the available UC data from this and another Australian study.

Conclusions
In contradistinction to UC, appendicectomy did not significantly influence the prevalence of the PSC groups, or the extent of colitis in PSC-IBD, but as with UC, did appear to delay their onset. The extensive milder colitis, which is characteristic of PSC-IBD, relates to other poorly understood factors. Further prospective studies are required to determine any influence of appendicectomy on the extent of colitis in IBD and an associated dysplasia or colorectal cancer.
Keyword Gastroenterology & Hepatology
Inflammatory-bowel-disease
Hepatobiliary disease
Crohns-disease
Risk
Cancer
Smoking
Childhood
Protects
Cells
Tonsillectomy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2005 Higher Education Research Data Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 28 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 40 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Wed, 15 Aug 2007, 05:09:21 EST