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| ORIGINAL ARTICLE
|Year : 2020 | Volume
| Issue : 4 | Page : 850--855
Association between Appendectomy and Demyelinating Disorders in Subjects 40 Years and Older
Hean S Ooi1, S Viswanathan2, Nevein P Botross3, Gaik B Eow4, Yen T Chin5, Ruban Kanesalingam6, Mohamed A R Isman7, Jia M Cheang7, Rusli Bin Nordin8, Suneet Sood9
1 Sir Charles Gairdner Hospital, Western Australia
2 Department of Neurology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
3 Department of Medicine, Monash University Malaysia, Johor Bahru, Malaysia
4 Hospital Pulau Pinang, Penang, Malaysia
5 Department of Medicine, Hospital Sultanah Aminah, Johor Bahru, Malaysia
6 Department of Neurology, KPJ Johor Specialist Hospital, Johor, Malaysia
7 Undergraduate Medical Student, Penang, Malaysia
8 School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
9 Department of Surgery, Monash University Malaysia, Johor Bahru, Malaysia
Background: The association between appendectomy and multiple sclerosis (MS) is unknown. In this study, we explored the association between appendectomy and MS and neuromyelitis optica spectrum disorder (NMOSD).
Patients and Methods: MS and NMOSD patients older than 40 were identified from neurology records from hospitals in Malaysia. The diagnoses were based on the Revised McDonald (2010) and Wingerchuk (2015) criteria. Controls were sampled from Malaysia's normal population. Individuals were interviewed telephonically or face-to-face. The age inclusion criterion (over 40) differentiated high or low lifetime risk of appendicitis, as appendicitis incidence is rare after 40.
Results: 49 MS, 71 NMOSD, and 880 controls met the inclusion criteria. Seventy-two individuals (9 MS, 4 NMOSD, 59 control) had undergone appendectomy. Appendectomy rates were 18.37% in the MS group (95% CI 7.5–29.2%), 5.6% in the NMOSD group (0.3%, 11%), and 6.7% among controls (5.1%, 8.4%), (MS vs NMOSD P = 0.036, MS vs controls P = 0.007). Binary regression analysis showed that MS was an independent risk factor for appendectomy (OR 2.938, 95% CI 1.302, 6.633, P = 0.009). NMOSD showed no association with appendectomy.
Conclusion: MS is positively associated with appendectomy, unlike ulcerative colitis, which is negatively associated. We hypothesize that there is a commonality in the microflora in persons who have had these two illnesses.
Dr. Suneet Sood
Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 8 Masjid Jalan Abu Bakar, 80100 Johor Bahru, Johor
Source of Support: None, Conflict of Interest: None
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