Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://www.gastrores.org

Original Article

Volume 17, Number 2, April 2024, pages 90-99

Mucosa-Associated Lymphoid Tissue Surgeries as a Possible Risk for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Figures

Figure 1.
Figure 1. PRISMA flow diagram showing study selection. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta Analysis.
Figure 2.
Figure 2. The association between MALTectomy (appendicectomy/tonsillectomy) and Crohn’s disease. (a) Forest plot of the association between MALTectomy (appendicectomy/tonsillectomy) and Crohn’s disease. (b) Funnel plot of the association between MALTectomy (appendicectomy/tonsillectomy) and Crohn’s disease. SE: standard error; CI: confidence interval; MALTectomy: mucosa-associated lymphoid tissue removal; OR: odds ratio.
Figure 3.
Figure 3. The association between MALTectomy (appendicectomy/tonsillectomy) and ulcerative colitis. (a) Forest plot of the association between MALTectomy (appendicectomy/tonsillectomy) and ulcerative colitis. (b) Funnel plot of the association between MALTectomy (appendicectomy/tonsillectomy) and ulcerative colitis. SE: standard error; CI: confidence interval; MALTectomy: mucosa-associated lymphoid tissue removal; OR: odds ratio.

Tables

Table 1. Summaries of Study Findings Association Between Surgical Procedures and IBD
 
StudyStudy designPopulation of interest (P)Study sampleSurgical procedure (intervention/comparison)OutcomesConclusion
IBD: inflammatory bowel disease; OR: odds ratio; CI: confidence interval; CD: Crohn’s disease; UC: ulcerative colitis; RR: relative risk; AHR: adjusted hazard ratio; HR: hazard ratio; H/o: history of.
Koutroubakis et al, 1999 [13]Case-control studyIBD vs. non-IBDUC: n = 134; CD: n = 76; non-IBD: n = 210Appendicectomy: n = 58; UC: n = 11; CD: n = 19Possibility of having appendicectomy (a risk factor) for developing IBD: 1) UC: OR: 0.6, 95% CI: 0.26 - 1.27; 2) CD: OR: 2.2, 95% CI: 0.94 - 5.121) History of tonsillectomy was associated with 229 higher odds of developing Crohn’s disease in comparison to non-IBD. 2) History of appendicectomy was associated with 120 higher odds of developing CD in comparison to non-IBD. 3) No association was seen between tonsillectomy and appendicectomy with UC.
Non appendicectomy: n = 362Tonsillectomy: 1) UC: OR: 0.95, 95% CI: 0.49 - 1.82; 2) CD: OR: 3.29, 95% CI: 1.29 - 8.37
Kurina et al, 2002 [16]Nested case-control studyIBD vs. non-IBDUC: n = 7,273; CD: n = 5,023; non-IBD: n = 749,322Appendectomy: n = 281Appendicectomy: 1) UC < 20 years: RR: 0.48, 95% Cl: 0.30 - 0.73; 2) CD ≥ 20 years: RR: 1.92, 95% CI: 1.58 - 2.32, < 20 years: RR: 0.71, 95% CI: 0.47 - 1.031) Appendicectomy is associated with reduced risk of UC, more specifically to young age groups. 2) Appendicectomy at age 20 or more correlated with Crohn’s disease; negative association when done at age less than 20. Increased risk of appendicectomy is probably attributable to the misdiagnosis of CD as appendicitis
Tonsillectomy: n = 274
No data on tonsillectomy
Bager et al, 2019 [15]Cohort studyTonsillectomy vs. non-tonsillectomyUC: n = 49,550; CD: n = 22,015; non-IBD: n = 6,973,723Tonsillectomy: n = 276,6731) UC: RR: 1.24, 95% CI: 1.18 - 1.29; 2) CD: RR: 1.52, 95% CI: 1.43 - 1.61Tonsillectomy increased the risk for both UC and CD
Non-tonsillectomy: n = 6,768,615
Chen et al, 2019 [17]Retrospective case-control studyCD vs. non-IBDCD: n = 617; non-IBD: n = 617Appendectomy: n = 64CD: OR: 1.878, 95% CI: 1.111 - 3.174, P = 0.019Prior appendectomy is a risk factor for CD; prior appendectomy did not affect the course or symptoms of the disease
Non-appendicectomy: n = 1,170
Chung et al, 2021 [18]Cohort studyAppendicectomy vs. non-appendicectomyUC: n = 165; CD: n = 177; non-IBD: n = 492,782Appendicectomy: n = 246,5621) UC: AHR: 2.23, 95% CI: 1.59 - 3.12; 2) CD: AHR: 3.48, 95% CI: 2.42 - 4.99Increased risk of IBD in patients undergoing appendectomy
Non-appendicectomy: n = 246,562
Fantodji et al, 2022 [19]Cohort studyAppendicectomy vs. non-appendicectomyUC: n = 1,134; CD: n = 2,545; non-IBD: n = 396,841Appendicectomy: n = 17,205UC: HR: 0.39, 95% CI: 0.22 - 0.71Increased risk of CD related to appendicectomy; protective effects for UC with appendectomy observed after 5 years
Non-appendicectomy: n = 383,315
CD: HR 2.02, 95% CI: 1.66 - 2.44
Kiasat et al, 2022 [14]Cohort studyH/o appendicitisUC: n = 619; CD: n = 529; non-IBD: n = 102,658H/o appendicitis: n = 52,391Appendicectomy: 1) IBD: AHR: 0.48, 95% CI: 0.42 - 0.55; 2) UC: AHR: 0.30, 95% CI: 0.25 - 0.36; 3) CD: AHR: 0.82, 95% CI: 0.68 - 0.97Childhood appendicitis treated with appendectomy has lower risk of IBD
No H/o appendicitis: n = 51,415
No H/o appendicitis
Appendicectomy: n = 50,421
Non-appendicectomy: n = 53,385
No appendectomy: 1) UC: AHR: 0.29, 95% CI: 0.12 - 0.69; 2) CD: AHR 1.12, 95% CI: 0.61 - 2.06

 

Table 2. Newcastle-Ottawa Scale
 
StudyNewcastle-Ottawa Scale
SelectionComparabilityOutcomeOverall risk of bias
*A lower bias, rated 1/5. **A relatively higher bias, rated 2/5.
Koutroubakis et al, 1999 [13]*****Moderate
Kurina et al, 2002 [16]*****Moderate
Bager et al, 2019 [15]******Moderate
Chen et al, 2019 [17]*****Moderate
Chung et al, 2021 [18]******Moderate
Fantodji et al, 2022 [19]******Moderate