PURPOSE: Appendectomy has been suggested as a possible protective factor in ulcerative colitis and as a risk factor in Crohn's disease. Tonsillectomy has also been associated with Crohn's disease. We performed a case-controlled study to investigate these associations in a homogeneous Greek population. METHODS: One hundred thirty-four consecutive cases of ulcerative colitis and 76 cases of Crohn's disease were included in the study. For each inflammatory bowel disease patient and a corresponding healthy control subject, matched for gender, age, and educational level, a standard record on various risk factors was completed by interview. The association between disease status and risk factors was assessed by Pearson's chi-squared test and the independent contribution of each risk factor was analyzed by means of logistic regression analysis. RESULTS: Appendectomy had been performed in 11 (8.2 percent) patients with ulcerative colitis, in 18 (13.4 percent) of their matched healthy control cases, in 19 (25.0 percent) patients with Crohn's disease, and in 10 (13.2 percent) of their matched healthy control cases. Odds ratio for development of ulcerative colitis after appendectomy was 0.6 (95 percent confidence interval, 0.26–1.27). Odds ratio for Crohn's disease was 2.2 (95 percent confidence interval, 0.94–5.12). Odds ratio for development of ulcerative colitis or Crohn's disease after tonsillectomy was 0.95 (95 percent confidence interval, 0.49–1.82) and 3.29 (95 percent confidence interval, 1.29–8.37), respectively. The logistic regression analysis showed that appendectomy and tonsillectomy have no independent association with the risk of developing ulcerative colitis, whereas in Crohn's disease both appendectomy and tonsillectomy have positive associations. Wellestablished risk factors, such as family history and smoking status, were also verified in this study. CONCLUSIONS: This case-control study, using multivariate logistic regression analysis, showed a less pronounced association between ulcerative colitis and appendectomy than previous reports. Our data also support the conclusion that tonsillectomy is a risk factor for developing Crohn's disease.
This is a preview of subscription content, log in to check access.
O'Morain C, Tobin A, Suzuki Y, O'Riordan T. Risk factors in inflammatory bowel disease. Scand J Gastroenterol Suppl 1989;170:58–60.
Persson PG, Leijonmarck CE, Bernell O, Hellers G, Ahlbom A. Risk indicators for inflammatory bowel disease. Int J Epidemiol 1993;22:268–72.
Koutroubakis I, Manousos ON, Meuwissen SG, Peña AS. Environmental risk factors in inflammatory bowel disease. Hepatogastroenterology 1996;43:381–93.
Rutgeerts P, D'Haens G, Hiele M, Geboes K, Vantrappen G. Appendectomy protects against ulcerative colitis. Gastroenterology 1994;106:1251–3.
Smithson JE, Radford-Smith G, Jewell GP. Appendectomy and tonsillectomy in patients with inflammatory bowel disease. J Clin Gastroenterol 1995;21:283–6.
Minocha A, Raczkowski CA. Role of appendectomy and tonsillectomy in pathogenesis of ulcerative colitis. Dig Dis Sci 1997;42:1567–9.
Russel MG, Dorant E, Brummer RJ,et al. South Limburg Inflammatory Bowel Disease Study Group. Appendectomy and the risk of developing ulcerative colitis or Crohn's disease: results of a large case-control study. Gastroenterology 1997;113:377–82.
Derby LE, Jick H. Appendectomy protects against ulcerative colitis. Epidemiology 1998;9:205–7.
Mate-Jimenez J, Correa-Estan JA, Perez-Miranda M, Gomez-Cedenilla A, Pajares JM, Moreno-Otero R. Tonsillectomy and inflammatory bowel disease location. Eur J Gastroenterol Hepatol 1996;8:1185–8.
Gilat T, Hacohen D, Lilos P, Langman MJ. Childhood factors in ulcerative colitis and Crohn's disease. An international cooperative study. Scand J Gastroenterol 1987;22:1009–24.
Higashi A, Watanabe Y, Ozasa K,et al. A case-control study of ulcerative colitis. Nippon Eiseigaku Zasshi 1991;45:1035–43.
Gent AE, Hellier MD, Grace RH, Swarbrick ET, Coggon D. Inflammatory bowel disease and domestic hygiene in infancy. Lancet 1994;343:766–7.
Breslin NP, McDonnell C, O'Morain C. Surgical and smoking history in inflammatory bowel disease: a case-control study. Inflammatory Bowel Diseases 1997;3:1–5.
Wurzelmann JI, Lyles CM, Sandler RS. Childhood infections and the risk of inflammatory bowel disease. Dig Dis Sci 1994;39:555–60.
Ekbom A, Adami HO, Helmick CG, Jonzon A, Zack MM. Perinatal risk factors for inflammatory bowel disease: a case-control study. Am J Epidemiol 1990;132:1111–9.
Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl 1989;24:2–6.
Lowenfels, AB. Appendectomy and ulcerative colitis [letter]. Gastroenterology 1994;107:1570.
Mizoguchi A, Mizoguchi E, Chiba C, Bhan AK. Role of appendix in the development of inflammatory bowel disease in TCR-alpha mutant mice. J Exp Med 1996;184:707–15.
Logan R. Appendectomy and ulcerative colitis: what connection? Gestroenterology 1994;106:1382–4.
Janowitz HD. Appendectomy/UC correlation needs more direct evidence [letter]. Gastroenterology 1998;114:618.
Manousos ON, Giannadaki E, Mouzas IA,et al. Ulcerative colitis is as common in Crete as in northern Europe: a 5-year prospective study. Eur J Gastroenterol Hepatol 1996;8:893–8.
Manousos ON, Koutroubakis I, Potamianos S, Roussomoustakaki M, Gourtsoyiannis N, Vlachonikolis IG. A prospective epidemiologic study of Crohn's disease in Heraklion, Crete. Incidence over a 5-year period. Scand J Gastroenterol 1996;31:599–3.
Thomas GA, Rhodes J, Green JT. Inflammatory bowel disease and smoking—a review. Am J Gastroenterol 1998;93:144–9.
Binder V, Orholm M. Familial occurrence and inheritance studies in inflammatory bowel disease. Neth J Med 1996;48:53–6.
Koutroubakis I, Peña AS. Genetics of inflammatory bowel disease. In: Allan RN, Rhodes JM, Hanauer SB, Keighley MR, Alexander-Williams J, Fazio VW, eds. Inflammatory bowel diseases. 3rd ed. New York: Churchill Livingstone, 1997;13–26.
About this article
Cite this article
Koutroubakis, I.E., Vlachonikolis, I.G., Kapsoritakis, A. et al. Appendectomy, tonsillectomy, and risk of inflammatory bowel disease. Dis Colon Rectum 42, 225–230 (1999). https://doi.org/10.1007/BF02237133
- Crohn's disease
- Environmental factors
- Ulcerative colitis