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The Appendix and IBD: Appendectomy Does Not Protect Against Ulcerative Colitis

It is now almost 9 years since Gilat et al. (I), in their international study of childhood factors in IBD, noted the rarity of appendectomies in patients with ulcerative colitis (UC) compared with their control population. The authors had “no ready explanation” of their finding and did not mention it in their summary. This clear-cut report evoked little interest, and most clinical epidemiologists concentrated on the relationship between IBD and cigarette smoking and sucrose consumption. The more recent report (in 1994) of Rutgeerts et al. (2), who were apparently unfamiliar with the older study confirming the rarity of appendectomy in UC, has revived interest in this finding because of the unequivocal title of their article, “Appendectomy Protects Against Ulcerative Colitis” and the suggestion that removal of the appendix might be a useful procedure because “the relative risk of developing UC with an intact appendix exceeds the risk factor associated with smoking.” As a result, the literature now contains six studies on the subject, four full reports, two in abstract form (including one of our own), letters to the Editor, commentary, and editorials, etc.