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P266. The effect of appendectomy on the clinical course of ulcerative colitis – A systematic review

T.J. Gardenbroek, E.J. Eshuis, C.Y. Ponsioen, D.T. Ubbink, G. D'Haens, W.A. Bemelman

Academic Medical Center, Amsterdam, The Netherlands

Aim: Since there is growing evidence in the literature linking prior appendectomy inversely with subsequent risk of the development of ulcerative colitis, the aim of this study was to examine the latest evidence on the effect of appendectomy on the clinical course in patients with ulcerative colitis (UC).

Materials and Methods: A systematic literature search of the electronic databases PubMed, the Cochrane library, and EMBASE was performed up to August 2nd, 2010 with both keywords and MeSH terms and consisted of: ulcerative colitis OR colitis, ulcerative [MESH] AND (appendix OR appendectomy OR appendicectomy OR appendiceal).

Studies designed to evaluate the effect of appendectomy on the clinical course in patients with UC were included. No limits were applied to the timing of appendectomy in UC patients. All controlled trials and observational studies designed to investigate this effect were selected. Inclusion was not otherwise restricted by study size, language, or publication type.

The methodological quality of the studies included was assessed using the Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Study selection, quality assessment and data extraction was independently done by two reviewers. Primary endpoints were the number of relapses, the use of steroids, the number of hospital admissions and the number of colectomies.

Results: The search resulted in 6 observational studies totalling 2532 patients; 5 case control studies and one cohort study. The overall quality of the studies was moderate. Due to clinical heterogeneity, no meta-analysis could be conducted. One study found lower relapse rates in patients who where appendectomised before onset of UC (ARR 21.5%; 95% CI −1.71%-45.92%). Another 2 studies found a lesser requirement for immunosuppression in appendectomised patients (ARR 20.2%; 95% CI 9.67%-30.46%) and ARR 21.4%; 95% CI 10.32%-32.97%), 2 studies found no differences in the requirement for immunosuppression. In addition, 2 studies found no significant differences in colectomy rates between the appendectomised and non-appendectomised patients, one study found higher colectomy rates in appendectomised patients (ARR 8.7%; 95% CI −1.29%-18.66%), and 2 studies found lower colectomy rates in appendectomised patients (ARR 21.4%; 95% CI 13.17%-28.79% and ARR 18.7%; 95% CI 7.50%-29.97%, respectively).

Conclusion: This review shows there is limited and conflicting data available regarding the effect of appendectomy on the clinical course of UC. Most studies suggest a beneficial effect, the minority find no or a negative effect. A prospective randomized trial evaluating the immunomodulating effect of appendectomy on the clinical course of UC is therefore justified.