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Appendectomy and the Risk of Colectomy in Ulcerative Colitis: A National Cohort Study
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
County Hospital Ryhov, Sweden; Oxford University Hospital NHS Fdn Trust, England.
Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
University of Birmingham, England.
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2017 (engelsk)Inngår i: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 112, nr 8, s. 1311-1319Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

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NATURE PUBLISHING GROUP , 2017. Vol. 112, nr 8, s. 1311-1319
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URN: urn:nbn:se:liu:diva-140061DOI: 10.1038/ajg.2017.183ISI: 000406780900020PubMedID: 28653667OAI: oai:DiVA.org:liu-140061DiVA, id: diva2:1136561
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Funding Agencies|Medical Research Council of Southeast Sweden; Ihre Foundation; Bengt Ihre Research Fellowship

Tilgjengelig fra: 2017-08-28 Laget: 2017-08-28 Sist oppdatert: 2017-09-14

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