Extract

We read with interest the article by S. Sahami et al., evaluating the modulating effect of appendectomy on the disease course of ulcerative colitis (UC) patients.1 The author found that appendectomy was effective in one-third of therapy-refractory UC patients. Because their findings are different from other studies,2 several questions deserve attention.

First, median age of the study population was 40 years. Several studies on the supposed protective role of appendectomy against UC concluded that appendectomy protects against UC only in patients who had surgery before the age of 20 years.3 Hence we wondered if the results of S. Sahami et al. might be different if the study population were analysed after stratification for patients younger and older than 20 years. Some studies have found that pathological changes (fibrosis) were found in more than half of appendices in patients undergoing colectomy for UC, and the proportion increased with age.4 It would explain why the apparent protection of appendectomy against UC in some studies was limited to younger patients.

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