Association of appendectomy with disease phenotype and clinical course in Crohn's disease: results from two cohorts.

BACKGROUND

The appendix, as a component of the digestive system, plays a role in intestinal immunity.

OBJECTIVE

To investigate the association between appendectomy history and disease phenotype/progression in Crohn's disease patients.

DESIGN

Two cohorts from a single center.

PATIENTS: Patients with Crohn's disease diagnosed between 2011 and 2021, including those without surgery and those undergoing their first surgery for Crohn's disease.

METHODS

Patients were divided into surgical and non-surgical cohorts, each further split into appendectomy and non-appendectomy groups.

RESULTS

In the non-surgical cohort, significant phenotypic disparities were observed between appendectomy-only and non-appendectomy groups across Montreal classification parameters, including age (p < 0.001), location (p = 0.03), and behavior (p = 0.01), with reduced perianal lesion prevalence in appendectomy patients (15% (9/60) vs. 35.7% (162/454), p = 0.001). Appendectomy patients exhibited later disease onset (IQR36 vs. 24 years, p < 0.001) and diagnosis (IQR37 vs. 26 years, p < 0.001). In the surgical cohort, significant differences emerged among non-appendectomy, appendectomy-only, and ileocecal resection groups in Montreal classification parameters: age at diagnosis (p = 0.014), location (p < 0.001), and behavior (p = 0.003). Disease progression timelines differed markedly, with later onset (IQR 29 vs. 27 vs. 25 years, p < 0.001), diagnosis (IQR 31 vs. 30 vs. 27 years, p < 0.001), and surgery (IQR 35 vs. 33 vs. 31 years, p < 0.001) observed in appendectomy-only patients. Surgical management varied significantly, including diagnosis-to-surgery intervals (mean 3.4 vs. 2.6 vs. 3.7 years, p < 0.001), perianal lesion (29.3% (123/420) vs. 24.4% (39/160) vs. 35.3% (173/490), p = 0.02), and one-stage surgery (36.2% (152/420) vs. 75.6% (120/160) vs. 66.1% (324/490), p < 0.001).

LIMITATIONS: Retrospective analysis with potential data biases.

CONCLUSION

Despite notable differences in disease phenotype, appendectomy does not seem to influence the clinical course of Crohn's disease. However, it seems to be associated with the lower risk of perianal disease and alleviates the severity of their condition.