Department of Surgery, Danderyd Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
Colorectal Dis. 2022 Aug;24(8):975-983. doi: 10.1111/codi.16128. Epub 2022 Apr 6.
The aim of this study was to investigate the association between juvenile appendicitis, treated conservatively or with appendectomy, and adult risk of inflammatory bowel disease (IBD), either ulcerative colitis (UC) or Crohn's disease (CD). We used nationwide population data from more than 100,000 individuals followed for over four decades.
All Swedish patients discharged with a diagnosis of appendicitis before the age of 16 years between 1973 to 1996 were identified. Everyone diagnosed with appendicitis was matched to an individual in the general population without a history of juvenile appendicitis (unexposed) of similar age, sex and region of residence. The study population was retrospectively followed until 2017 for any development of UC or CD. Cox proportional-hazards models compared disease-free survival time between exposed and unexposed individuals, also analysing the impact of treatment (conservative treatment versus appendectomy).
The final cohort consisted of 52,391 individuals exposed to appendicitis (1,674,629 person years) and 51,415 unexposed individuals (1,638,888 person years). Childhood appendicitis with appendectomy was associated with a significantly lower risk of adult IBD [adjusted hazard ratio (aHR) 0.48 (0.42-0.55)], UC [aHR 0.30 (0.25-0.36)] and CD [aHR 0.82 (0.68-0.97)]. Those treated conservatively had a lower risk of adult UC [aHR 0.29 (0.12-0.69)] but not CD [aHR 1.12 (0.61-2.06)] compared with unexposed individuals.
Juvenile appendicitis treated with appendectomy was associated with a decreased risk of adult IBD, both UC and CD. Those treated conservatively instead of with surgery had a lower risk of UC only. Our findings warrant more research on the role of the appendix and gut microbiota in the pathogenesis of IBD.
本研究旨在探讨青少年阑尾炎（经保守治疗或阑尾切除术治疗）与成年后炎症性肠病（IBD）的相关性，包括溃疡性结肠炎（UC）或克罗恩病（CD）。我们使用了超过 100,000 名个体的全国性人群数据，这些个体在 40 多年的时间里接受了随访。
确定了 1973 年至 1996 年间所有 16 岁以下因阑尾炎住院的瑞典患者。每位确诊阑尾炎的患者都与一名无青少年阑尾炎病史（未暴露）的一般人群中的个体相匹配，这些个体年龄、性别和居住地区相似。研究人群被回溯性随访至 2017 年，以观察任何 UC 或 CD 的发展情况。Cox 比例风险模型比较了暴露和未暴露个体的无疾病生存时间，并分析了治疗（保守治疗与阑尾切除术）的影响。
最终队列包括 52391 名患有阑尾炎的个体（1674629 人年）和 51415 名未暴露个体（1638888 人年）。阑尾切除术治疗的儿童阑尾炎与成年 IBD 的风险显著降低相关[校正后的危险比（aHR）0.48（0.42-0.55）]，UC[aHR 0.30（0.25-0.36）]和 CD[aHR 0.82（0.68-0.97）]。与未暴露个体相比，保守治疗的个体患成年 UC 的风险较低[aHR 0.29（0.12-0.69）]，但患 CD 的风险无差异[aHR 1.12（0.61-2.06）]。
阑尾切除术治疗的青少年阑尾炎与成年后 IBD（包括 UC 和 CD）的风险降低相关。与手术治疗相比，保守治疗的个体仅患 UC 的风险较低。我们的发现需要进一步研究阑尾和肠道微生物群在 IBD 发病机制中的作用。
