Appendectomy and Proctitis

[Crohn2357]

In a prospective case series, 30 adult patients with ulcerative proctitis underwent an appendectomy, in the absence of history suggestive of previous appendicitis, in order to evaluate its potential therapeutic role [74]. After an appendectomy, the clinical activity index, calculated with the Simple Clinical Colitis Activity Index, improved significantly in 27 out of 30 patients (90%), while the index remained unchanged in the remaining 3 out of 30 patients (10%) [74]. In addition, 12 of 30 patients (40%) had complete resolution of symptoms within 12 months, such that all drug treatments could be discontinued, and remained in remission from all previous treatments for a median of 9 months (range 6–25 months) [74]. The time required for a complete resolution of symptoms after an appendectomy ranged from 1 to 12 months (median 3 months) [74].

In another case series of eight patients treated for refractory ulcerative proctitis, elective appendectomy was performed without symptoms of appendicitis. All patients had a Mayo score at endoscopy of 1 or greater and had healing of the proctitis mucosa, with a follow-up of 3.6 years. Four patients had a single moderate flare-up that responded to topical therapy; four of the eight appendixes removed were macroscopically normal, while the others had a macroscopically inflamed appendix. All patients had signs of acute mucosal inflammation and a transmural neutrophilic infiltrate, typical of acute appendicitis [75].

These studies provided the rationale for conducting controlled trials to properly evaluate the role of appendectomy in the treatment of UP.

Diletta De Deo, Arianna Dal Buono, Roberto Gabbiadini, Paola Spaggiari, Anita Busacca, Benedetta Masoni, Silvia Ferretti, Cristina Bezzio & Alessandro Armuzzi (2024) Management of proctitis in ulcerative colitis and the place of biological therapies, Expert Opinion on Biological Therapy, 24:6, 443-453, DOI: 10.1080/14712598.2024.2369189

 

[Crohn2357]

https://www.healingwell.com/community/default.aspx?f=38&m=2213022&g=2213040

 

[Crohn2357]

 

[Scipio]

I have Crohn's and not UC, but in my case appendectomy didn't help. I had an emergency appendectomy due to appendicitis with ruptured appendix. One year later I was diagnosed with Crohn's disease.

 

[Crohn2357]

I have Crohn's and not UC, but in my case appendectomy didn't help. I had an emergency appendectomy due to appendicitis with ruptured appendix. One year later I was diagnosed with Crohn's disease.

You might have CD before the appendectomy.

 

[Scipio]

You might have CD before the appendectomy.

I'm sure that I very likely did. But the ulcerative proctitis patients in the study cited in the first post above also had their disease prior to their appendectomies. Some of them apparently benefitted from the procedure with reduced IBD symptoms. By contrast, my CD symptoms got much worse over the course of my post-appendectomy year to the extent that the GI was finally able to firmly diagnose the Crohn's.

 

[Crohn2357]

The case series are about elective appendectomy. Unlike your case, the patients had appendectomy without a need for it. This may be an important factor.

How long did it take for you to get into remission after your Stelara injection intervals were halved? Have you had scopes to confirm the remission?

 

[Scipio]

How long did it take for you to get into remission after your Stelara injection intervals were halved? Have you had scopes to confirm the remission?

You might be confusing me with another forum member. My Stelara dosing is the standard 90 mg dose every 56 days and has not changed since I started on the drug about 7 years ago. Back when I started on the Stelara my symptoms noticeably improved after 2 or 3 weeks and achieved near-complete remission (only minor residual inflammation left) after about 2 moths.