Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Department of Surgery, County Council of Östergötland, Linköping, Sweden.
Am J Gastroenterol. 2017 Aug;112(8):1311-1319. doi: 10.1038/ajg.2017.183. Epub 2017 Jun 27.
Ulcerative colitis (UC) is a chronic inflammatory disease usually responding well to anti-inflammatory drugs but many patients will still need colectomy. Appendectomy is associated with a lower risk of later developing UC. We aimed to assess the longitudinal relationship between appendectomy, appendicitis, and disease course in UC patients.
A national cohort of UC patients with a diagnosis in 1964-2010 was identified from the Swedish National Patient Register that also provided information regarding appendicitis and/or appendectomy before or after the UC diagnosis. The risk for colectomy and UC-related hospital admissions was evaluated.
Among 63,711 UC patients, 2,143 had appendectomy and 7,690 underwent colectomy. Appendectomy for appendicitis before 20 years of age and for non-appendicitis at all ages before UC diagnosis was associated with a lower risk of colectomy (hazard ratio (HR) 0.44, 0.27-0.72 and HR 0.62, 0.43-0.90, respectively), and fewer hospital admissions (incidence rate ratio (IRR) 0.68, 95% confidence interval (CI) 0.64-0.73 and IRR 0.54, 0.47-0.63, respectively). Appendectomy for appendicitis after the UC diagnosis was associated with a higher risk of colectomy (HR 1.56, 1.20-2.03), whereas no such association was found for other pathology (HR 1.40, 0.79-2.47).
Appendectomy early in life and before developing UC is associated with a lower risk of colectomy as well as UC-related hospital admissions. Appendectomy for appendicitis after established UC appears associated with a worse disease course, with an increased rate of subsequent colectomy.
溃疡性结肠炎（UC）是一种慢性炎症性疾病，通常对抗炎药物反应良好，但许多患者仍需要结肠切除术。阑尾切除术与较低的 UC 发病风险相关。本研究旨在评估 UC 患者中阑尾切除术、阑尾炎与疾病过程之间的纵向关系。
从瑞典国家患者登记处确定了 1964 年至 2010 年诊断为 UC 的全国性队列，该登记处还提供了 UC 诊断之前或之后阑尾炎和/或阑尾切除术的信息。评估了结肠切除术和 UC 相关住院的风险。
在 63711 例 UC 患者中，2143 例患者行阑尾切除术，7690 例患者行结肠切除术。20 岁前因阑尾炎行阑尾切除术和 UC 诊断前任何年龄因非阑尾炎行阑尾切除术与较低的结肠切除术风险相关（风险比（HR）0.44，0.27-0.72 和 HR 0.62，0.43-0.90），且住院次数较少（发病率比（IRR）0.68，95%置信区间（CI）0.64-0.73 和 IRR 0.54，0.47-0.63）。UC 诊断后因阑尾炎行阑尾切除术与较高的结肠切除术风险相关（HR 1.56，1.20-2.03），而其他病理类型无此关联（HR 1.40，0.79-2.47）。
早年和 UC 发病前行阑尾切除术与较低的结肠切除术风险以及 UC 相关住院率相关。UC 确诊后因阑尾炎行阑尾切除术似乎与更差的疾病过程相关，随后结肠切除术的发生率增加。
