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Maret-Ouda J, Ström JC, Roelstraete B, Emilsson L, Joshi AD, Khalili H, Ludvigsson JF. Appendectomy and Future Risk of Microscopic Colitis: A Population-Based Case-Control Study in Sweden. Clin Gastroenterol Hepatol 2023; 21:467-475.e2. [PMID: 35716902 DOI: 10.1016/j.cgh.2022.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Microscopic colitis (MC) is an inflammatory bowel disease and a common cause of chronic diarrhea. Appendectomy has been suggested to have immunomodulating effects in the colon, influencing the risk of gastrointestinal disease. The relationship between appendectomy and MC has only been sparsely studied. METHODS This was a case-control study based on the nationwide ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort, consisting of histopathological examinations in Sweden, linked to national registers. Patients with MC were matched to population controls by age, sex, calendar year of biopsy, and county of residence. Data on antecedent appendectomy and comorbidities were retrieved from the Patient Register. Unconditional logistic regression models were conducted presenting odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for country of birth and matching factors. Further subanalyses were made based on MC subtypes (lymphocytic colitis and collagenous colitis), follow-up time postappendectomy and severity of appendicitis. RESULTS The study included 14,520 cases of MC and 69,491 controls, among these 7.6% (n = 1103) and 5.1% (n = 3510), respectively, had a previous appendectomy ≥1 year prior to MC or matching date. Patients with a previous appendectomy had an increased risk of MC in total (OR, 1.50; 95% CI, 1.40-1.61) and per the collagenous colitis subtype (OR, 1.67; 95% CI, 1.48-1.88) or lymphocytic colitis subtype (OR, 1.42; 95% CI, 1.30-1.55). The risk remained elevated throughout follow-up, and the highest risk was observed in noncomplicated appendicitis. CONCLUSIONS This nationwide case-control study found a modestly increased risk of developing MC following appendectomy.
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Affiliation(s)
- John Maret-Ouda
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
| | - Jennifer C Ström
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Bjorn Roelstraete
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Louise Emilsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Science, University of Örebro, Örebro, Sweden; Värmlands Nysäter Health Care Center and Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Amit D Joshi
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussets
| | - Hamed Khalili
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussets; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachussets
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
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Thompson JS, Mannon P. Celiac disease and the surgeon. Am J Surg 2022; 224:332-338. [PMID: 35221098 DOI: 10.1016/j.amjsurg.2022.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
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Ugge H, Udumyan R, Carlsson J, Davidsson S, Andrén O, Montgomery S, Fall K. Appendicitis before Age 20 Years Is Associated with an Increased Risk of Later Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:660-664. [PMID: 29588305 DOI: 10.1158/1055-9965.epi-17-1204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/20/2018] [Accepted: 03/23/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Appendicitis before age 20 years has been observed to influence the risk of several inflammatory conditions, possibly through underlying immunological mechanisms. Inflammation has further been suggested to be involved in prostate cancer development. We therefore hypothesized that immunological characteristics signaled by appendicitis before late adolescence might influence the risk of later prostate cancer, and aimed to evaluate this association in a population-based study.Methods: We identified a large cohort of Swedish men who underwent assessment for military conscription around the age of 18 years (n = 242,573). Medical diagnoses at time of conscription were available through the Swedish Military Conscription Register. The Swedish Cancer Register was used to identify diagnoses of prostate cancer. Multivariable adjusted Cox regression analyses were used to estimate HR and 95% confidence intervals (95% CIs) for the association between appendicitis and prostate cancer.Results: During a median of 36.7 years of follow-up, 1,684 diagnoses of prostate cancer occurred. We found a statistically significant association between appendicitis and overall prostate cancer (adjusted HR 1.70; 95% CI, 1.08-2.67). The risk was notably increased for advanced (HR 4.42; 95% CI, 1.74-11.22) and lethal (HR 8.95; 95% CI, 2.98-26.91) prostate cancer.Conclusions: These results suggest that a diagnosis of appendicitis before adulthood potentially signals underlying immune characteristics and a pattern of inflammatory response relevant to prostate cancer risk.Impact: The study lends support to the proposed role of inflammation in prostate carcinogenesis, and adds another area of investigation potentially relevant to prostate cancer development. Cancer Epidemiol Biomarkers Prev; 27(6); 660-4. ©2018 AACR.
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Affiliation(s)
- Henrik Ugge
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jessica Carlsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sabina Davidsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ove Andrén
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
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Appendectomy and the Risk of Colectomy in Ulcerative Colitis: A National Cohort Study. Am J Gastroenterol 2017; 112:1311-1319. [PMID: 28653667 DOI: 10.1038/ajg.2017.183] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/21/2017] [Indexed: 12/11/2022]
Abstract
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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Kurien M, Sanders DS, Ekbom A, Ciacci C, Ludvigsson JF. Increased rate of abdominal surgery both before and after diagnosis of celiac disease. Dig Liver Dis 2017; 49:147-151. [PMID: 27765577 DOI: 10.1016/j.dld.2016.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The detection of celiac disease (CD) is suboptimal. AIMS We hypothesized that misdiagnosis is leading to diagnostic delays, and examine this assertion by determining if patients have increased risk of abdominal surgery before CD diagnosis. METHODS Through biopsy reports from Sweden's 28 pathology departments we identified all individuals with CD (Marsh stage 3; n=29,096). Using hospital-based data on inpatient and outpatient surgery recorded in the Swedish Patient Register, we compared abdominal surgery (appendectomy, laparotomy, biliary tract surgery, and uterine surgery) with that in 144,522 controls matched for age, sex, county and calendar year. Conditional logistic regression estimated odds ratios (ORs). RESULTS 4064 (14.0%) individuals with CD and 15,760 (10.9%) controls had a record of earlier abdominal surgery (OR=1.36, 95% CI=1.31-1.42). Risk estimates were highest in the first year after surgery (OR=2.00; 95% CI=1.79-2.22). Appendectomy, laparotomy, biliary tract surgery, and uterine surgery were all associated with having a later CD diagnosis. Of note, abdominal surgery was also more common after CD diagnosis (hazard ratio=1.34; 95% CI=1.29-1.39). CONCLUSIONS There is an increased risk of abdominal surgery both before and after CD diagnosis. Surgical complications associated with CD may best explain these outcomes. Medical nihilism and lack of CD awareness may be contributing to outcomes.
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Affiliation(s)
- Matthew Kurien
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom; Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - David S Sanders
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom; Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Anders Ekbom
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carolina Ciacci
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Tsai MC, Lin HC, Lee CZ. Diabetes increases the risk of an appendectomy in patients with antibiotic treatment of noncomplicated appendicitis. Am J Surg 2016; 214:24-28. [PMID: 27616688 DOI: 10.1016/j.amjsurg.2016.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/23/2016] [Accepted: 07/23/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND This retrospective cohort study examined whether diabetic patients have a higher risk for recurrent appendicitis during a 1-year follow-up period after successful antibiotic treatment for patients with acute uncomplicated appendicitis than nondiabetic patients using a population-based database. METHODS We included 541 appendicitis patients who received antibiotic treatment for acute appendicitis. We individually tracked each patient for a 1-year period to identify those who subsequently underwent an appendectomy during the follow-up period. RESULTS Cox proportional hazard regressions suggested that the adjusted hazard ratio of an appendectomy during the 1-year follow-up period was 1.75 for appendicitis patients with diabetes than appendicitis patients without diabetes. We found that among females, the adjusted hazard ratio of an appendectomy was 2.18 for acute appendicitis patients with diabetes than their counterparts without diabetes. However, we failed to observe this relationship in males. CONCLUSIONS We demonstrated a relationship between diabetes and a subsequent appendectomy in females who underwent antibiotic treatment for noncomplicated appendicitis.
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Affiliation(s)
- Ming-Chieh Tsai
- Division of Gastroenterology, Department of Internal Medicine, Hsinchu Cathay General Hospital, Taipei, Taiwan; School of Health Care Administration, Taipei Medical University Hospital, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University Hospital, Taipei, Taiwan; Sleep Research Center, Taipei Medical University, Taipei, Taiwan
| | - Cha-Ze Lee
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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Chen CH, Tsai MC, Lin HC, Lee HC, Lee CZ, Chung SD. Appendectomy increased the risk of ischemic heart disease. J Surg Res 2015; 199:435-40. [DOI: 10.1016/j.jss.2015.06.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/02/2015] [Accepted: 06/19/2015] [Indexed: 10/23/2022]
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An appendectomy increases the risk of rheumatoid arthritis: a five-year follow-up study. PLoS One 2015; 10:e0126816. [PMID: 25970542 PMCID: PMC4430489 DOI: 10.1371/journal.pone.0126816] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/08/2015] [Indexed: 12/12/2022] Open
Abstract
Many studies have reported a possible association of an appendectomy with rheumatoid arthritis (RA). However, findings of the relationship between an appendectomy and RA remain inconsistent. Furthermore, all such studies were conducted in Western societies, and relevant studies on the relationship between an appendectomy and RA in Asian countries are still lacking. In this study, we investigated the relationship between an appendectomy and the subsequent risk of RA using a population-based dataset. We retrieved data for this retrospective cohort study from the Taiwan "Longitudinal Health Insurance Database 2005". We included 4,294 subjects who underwent an appendectomy in the study cohort and 12,882 matched subjects in the comparison cohort. We individually tracked each subject for a 5-year period from their index date to identify those who developed RA. A stratified Cox proportional hazard regression was performed to calculate the hazard ratio (HR) and its corresponding 95% confidence interval (CI) for the subsequent development of RA during the 5-year follow-up period between subjects who underwent an appendectomy and comparison subjects. Of the sampled subjects, 93 (0.54%) received a diagnosis of RA during the 5-year follow-up period: 33 from the study cohort (0.77% of subjects who underwent an appendectomy) and 60 from the comparison cohort (0.47% of comparison subjects) (p<0.001). After censoring individuals who died during the follow-up period and adjusting for subjects' monthly income and geographic region, the HR of RA during the 5-year follow-up period was 1.61 (95% CI = 1.05~2.48) for subjects who underwent an appendectomy compared to comparison subjects. We found that among females, the adjusted HR of RA was 1.76 (95% CI = 1.04~2.96) for subjects who underwent an appendectomy compared to comparison subjects. However, there was no increased hazard of RA for males who underwent an appendectomy compared to comparison subjects. We concluded that female subjects who undergo an appendectomy have a higher risk of RA than comparison female subjects.
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Janszky I, Mukamal KJ, Dalman C, Hammar N, Ahnve S. Childhood appendectomy, tonsillectomy, and risk for premature acute myocardial infarction--a nationwide population-based cohort study. Eur Heart J 2011; 32:2290-6. [PMID: 21632600 DOI: 10.1093/eurheartj/ehr137] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS Although inflammation contributes to cardiovascular disease, the associations of appendectomy and tonsillectomy, which remove mucosa-associated lymphoid tissue, with risk of acute myocardial infarction (AMI) are unknown. Our aim was to assess the association between these operations performed in childhood and AMI risk later in life. METHODS AND RESULTS We conducted a prospective matched cohort study among all Swedish residents born between 1955 and 1970. A national register identified all appendectomies and tonsillectomies. For each patient undergoing appendectomy or tonsillectomy, we randomly selected five controls without the history of the respective operation, matched on sex, age, and county of residence. Participants were followed for fatal and non-fatal AMI for an average of 23.5 years. Because appendiceal and tonsillar tissues have reduced function after adolescence, our primary analyses were restricted to individuals below age 20 at the time of surgery (54 449 appendectomies and 27 284 tonsillectomies). We derived hazard ratios (HRs) from proportional hazard models adjusted for parental occupation and parental history of AMI. Operations before 20 years of age were associated with an increased risk for AMI (417 and 216 events in the appendectomy and tonsillectomy datasets, respectively), with adjusted HRs of 1.33 [95% confidence interval (CI), 1.05-1.70] for appendectomy and 1.44 (95% CI, 1.04-2.01) for tonsillectomy. This association was graded, with the highest risk among those undergoing both procedures, and generally similar among both males and females. Appendectomy and tonsillectomy performed at or above 20 years of age were not associated with the risk of AMI. CONCLUSIONS We found a higher risk of AMI related to surgical removal of the tonsils and appendix before age 20. These results are consistent with the hypothesis that subtle alterations in immune function following these operations may alter the subsequent cardiovascular risk, but further studies are needed to confirm these findings and to explore possible mechanisms.
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Affiliation(s)
- Imre Janszky
- Department of Public Health Sciences, Karolinska Institutet, Norrbacka, Karolinska University Hospital, Stockholm, Sweden.
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Roshanisefat H, Bahmanyar S, Hillert J, Olsson T, Montgomery SM. Appendicectomy and multiple sclerosis risk. Eur J Neurol 2010; 18:667-9. [PMID: 20629715 DOI: 10.1111/j.1468-1331.2010.03147.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rostami K, Villanacci V. Microscopic enteritis: novel prospect in coeliac disease clinical and immuno-histogenesis. Evolution in diagnostic and treatment strategies. Dig Liver Dis 2009; 41:245-52. [PMID: 18657490 DOI: 10.1016/j.dld.2008.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 06/11/2008] [Accepted: 06/12/2008] [Indexed: 12/11/2022]
Abstract
The diagnosis of coeliac disease has traditionally depended on symptoms and intestinal biopsies; nowadays, the diagnosis has been expanded to include an array of serological markers and subtle microscopic lesions. The most important advance in classifying mucosal lesions in coeliac disease was forwarded by Marsh (1992), who provided the biological explanation of how the small bowel reacts to a variety of environmental antigenic challenges including gluten. In the modified version of this classification (Arnhem 1998-1999) autoantibodies have integrated into Marsh's histopathological scheme. As a large part of the coeliac 'iceberg' remains unrecognised, the difficulties in diagnosis continue to challenge clinicians and researchers. Advances in immuno-histochemistry and discovery of the other sensitive markers have acquainted us with so-called Microscopic enteritis, the distinctive subtle abnormalities behind the atypical gluten sensitivity symptoms that often remain unrecognised. Current diagnostic pathways do not always include facilities for looking for this common histological feature in atypical cases. This is essential since improving of the detection rate has been shown to be directly proportional to recognition of cases with milder or minimal mucosal abnormalities. In this revision, we will define and characterise microscopic enteritis as the entity behind a wide range of unexplained gastrointestinal symptoms. Screening for this subtle and distinctive presentation in small bowel pathology will open a new prospect in recognising the most common but unrecognised atypical forms of symptomatic gluten related enteropathies.
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Affiliation(s)
- K Rostami
- School of Medicine, University of Birmingham, UK.
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Ludvigsson JF, Montgomery SM, Ekbom A. Risk of pancreatitis in 14,000 individuals with celiac disease. Clin Gastroenterol Hepatol 2007; 5:1347-53. [PMID: 17702659 DOI: 10.1016/j.cgh.2007.06.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to examine the risk of pancreatitis in patients with celiac disease (CD) from a general population cohort. METHODS By using Swedish national registers, we identified 14,239 individuals with a diagnosis of CD (1964-2003) and 69,381 reference individuals matched for age, sex, calendar year, and county of residence at the time of diagnosis. Cox regression estimated the hazard ratios (HRs) for a subsequent diagnosis of pancreatitis. We restricted analyses to individuals with more than 1 year of follow-up and no diagnosis of pancreatitis before or within 1 year after study entry. Conditional logistic regression estimated the association of pancreatitis with subsequent CD. RESULTS CD was associated with an increased risk of subsequent pancreatitis of any type (HR, 3.3; 95% confidence interval [CI], 2.6-4.4; P < .001; on the basis of 95 positive events in individuals with CD vs 163 positive events in reference individuals) and chronic pancreatitis (HR, 19.8; 95% CI, 9.2-42.8; P < .001; on the basis of 37 and 13 positive events, respectively). Adjustment for socioeconomic index, diabetes mellitus, alcohol-related disorders, or gallstone disease had no notable effect on the risk estimates. The risk increase for pancreatitis was only found among individuals with CD diagnosed in adulthood. Pancreatitis of any type (odds ratio, 3.2; 95% CI, 2.5-4.3; P < .001) and chronic pancreatitis (odds ratio, 7.3; 95% CI, 4.0-13.5; P < .001) were associated with subsequent CD. CONCLUSIONS This study suggests that individuals with CD are at increased risk of pancreatitis.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Pediatrics, Orebro University Hospital, Linkoping, Sweden.
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