Individuals who have undergone an appendectomy are more susceptible to Crohn’s disease.
This is the finding of a recent systematic review and meta-analysis at the Advances in Inflammatory Bowel Diseases annual meeting.
The research suggests that individuals who undergo appendectomy may face an elevated risk of developing Crohn’s disease (CD) but not ulcerative colitis (UC).
Dr Suprada Vinyak, of Ballad Health in Norton, Virginia, unveiled surprising results that challenge conventional expectations.
The meta-analysis demonstrated a pooled odds ratio (OR) of 1.57 (95% CI 1.01-2.43, P<0.00001) for CD among individuals who underwent surgery of the mucosa-and-gut lymphoid tissue (MALT/GALT).
However, Dr Vinyak and her colleagues emphasised a significant challenge in the form of high heterogeneity, with a staggering 93% observed.
In a somewhat unexpected turn, the researchers reported a 40% reduction in the risk of UC following MALT surgery, revealing a pooled OR of 0.60 (95% CI 0.24-1.57, P<0.00001).
Despite this positive outcome, a high level of heterogeneity (96%) was again noted. Dr Vinyak expressed surprise at this finding: ‘To be honest, I can’t explain it. We were expecting both CD and UC to be associated with appendectomy.’
Commenting on the findings, Dr Daniel Weintraub of Gastro Health Boca Raton and West Boca Medical Centre in Florida remarked that the relationship between appendectomy and CD remains an open question.
He explained: ‘Often, when people have imaging done for an IBD work-up, they (clinicians) will see inflammation in the right colon where the appendix is. Sometimes surgeons who are preparing for an appendectomy will see in their work-up some accompanying inflammation in the cecum where Crohn’s arises.’
Dr Waintraub, who was not involved in the study, acknowledged the perplexing nature of the appendix, traditionally considered vestigial, and suggested that this new information may challenge conventional wisdom. He added: ‘This is interesting work and suggests we need more studies in this area.’
Dr Vinyak told MedPage Today that the research was initiated due to the observation that many patients with CD or UC had a common factor – appendectomy.
She said, ‘ We became interested in this when we realised that in many of our patients with CD or with UC, the common denominator was an appendectomy. So we decided to look into this by doing medical literature searches.’
The researchers highlighted the importance of MALT/GALT in immune regulation and gut microbiota balance, acknowledging that while dysbiosis has been reported in IBD patients, a direct association remains unclear.
The meta-analysis incorporated 23 observational studies and six high-level evidentiary studies.
She concluded: ‘There are several unanswered questions. We don’t know from this study whether appendectomy preceded CD or vice versa, although we are looking into that in further work. We are also trying to work out the mechanisms of action that would cause one or the other.’
She believes the findings contribute to a better understanding of the links between MALT surgery and IBD, sparking the need for further research.
Dr Vinyak is currently enrolled in Ballad Health’s residency programme at Norton Community Hospital. She specialises in internal medicine and has a particular interest in gastroenterology.
She is committed to raising awareness about Crohn’s disease, an area witnessing growth in research and medical advancements.
Credit: Instagram: balladhealth
