Appendectomy and subsequent risk of inflammatory bowel diseases
Appendectomy and subsequent risk of inflammatory bowel diseases
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DOI：
10.1067/msy.2001.115362
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发表时间：
2001-07-01
期刊：
影响因子：
3.8
通讯作者：
Olsen, JH
中科院分区：
文献类型：
--
作者：
Frisch, M;Johansen, C;Olsen, JH
背景资料。病例对照研究已经报道了阑尾切除与溃疡性结肠炎风险之间的负相关关系，但这种关系在前瞻性研究中尚未得到证实。使用丹麦国家医院出院登记数据，作者对1977至1989年间接受阑尾切除术的154,434名患者进行了跟踪调查，以调查他们是否随后因溃疡性结肠炎和克罗恩病而住院。炎症性肠病首次住院的观察与预期比率可作为相对风险(RR)的衡量标准。接受阑尾切除术的84名患者中有84人因溃疡性结肠炎住院，而预期为97.0人(RR=0.87；95%CI，0.69-1.09)。在按性别、年龄、自阑尾切除以来的时间、历期或阑尾切除原因定义的亚组中，RR没有显著降低。因克罗恩病住院的患者较多(RR=2.88；95%CI，2.45~3.39；n=150)，尤其是在阑尾切除术后1年(RR=10.83；95%CI，8.49~13.62；n=73)；这项基于人群的大型队列研究未能支持阑尾切除术与溃疡性结肠炎风险之间的显著负相关。阑尾切除术后不久克罗恩病的增多很可能反映了新出现遗弃疼痛的患者的鉴别诊断问题。
Background. Case-control studies have reported an inverse relationship between appendectomy and the risk of ulcerative colitis, but the association has not been confirmed in prospective studies.Methods. Using national hospital discharge registry data in Denmark, the authors followed up 154,434 patients who underwent appendectomy during the period 1977 to 1989 to investigate whether they had subsequent hospitalizations for ulcerative colitis and Crohn's disease. Ratios of observed-to-expected first hospitalizations for inflammatory bowel diseases served as measures of the relative risk (RR).Results. Hospitalization for ulcerative colitis occurred in 84 patients who had appendectomies versus 97.0 expected (RR = 0.87; 95% CI, 0.69-1.09). RRs were not significantly reduced in subgroups defined by sex, age, time since appendectomy, calendar period, or cause of appendectomy. Hospitalization for Crohn's disease occurred in excess (RR = 2.88; 95% CI, 2.45-3.39: n = 150), notably in the first year after appendectomy (RR = 10.83; 95% CI, 8.49-13.62; n = 73); but after 5 year, the RR was not significantly elevated.Conclusions. This large population-based cohort study failed to support a significant inverse association between appendectomy and ulcerative colitis risk in the first decade after the operation. The excess of Crohn's disease shortly after appendectomy most likely reflects differential diagnostic problems in patients newly presenting with abandoned pain.