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Ulcerative proctitis can often be managed with appendectomy, Australian investigators reported last week at Digestive Disease Week 2010 in New Orleans.
So far, they've observed clinical responses of up to three years in patients they've treated this way.
"About 85% of 60 patients are quite significantly better, with half able to come off all therapy after about a year," Dr. Terry Bolin, who presented the results, told Reuters Health. Dr. Bolin is at Prince of Wales Hospital, Randwick, New South Wales.
"I sometimes use appendicectomy as first-line therapy, because other treatments take time, are not guaranteed to work, and they're not a lifelong cure as this potentially might be," he said.
Session moderator Dr. Uma Mahadevan-Velayos, from the University of California, San Francisco, told Reuters Health - not surprisingly -- "I think these results obviously have to be taken with caution."
"Doing abdominal surgery is a major intervention, and his comment that it should be first-line therapy is not appropriate, since we have 5-aminosalicylates, which are very low risk and very effective for the majority of patients," she said.
On the other hand, this option may be feasible for a patient with a severe flare for whom colectomy is being considered, she continued. "Just removing their appendix is a better option than removing their colon."
In their meeting abstract, Dr. Bolin and colleagues report on 50 patients with ulcerative proctitis who had appendectomies. (They reported on their first 30 patients last year, in a paper in the American Journal of Gastroenterology.)
The median Simple Clinical Colitis Activity Index improved from 9 to 2 (p < 0.0005) in 40 patients; the other 10 patients had no change. (The maximum score on the Simple Clinical Colitis Activity Index is 15, plus 1 point for every extra-colonic manifestation.)
Thirty-seven patients have had sustained clinical responses. The other three have had flares that responded to medical treatment - whereas prior to surgery, medical treatment was ineffective.
"We can't predict who's going to respond," Dr. Bolin said. None of the factors they've looked at -- age, sex, disease duration, histopathology of the appendix - was related to clinical outcome.
He said he has tried this approach for five patients with more extensive colitis, three of whom "got better." One has been able to go off medication.
"I think this is a very intriguing idea, and there is evidence there may be something here based on population-based studies," said Dr. Mahadevan-Velayos. She noted that "a fairly consistent literature" shows that patients who have an appendectomy early in life are less likely to develop ulcerative colitis later in life, "so there does appear to be a connection between the appendix and ulcerative colitis."
The study's major limitation is the failure to document endoscopically that there was mucosal healing after appendectomy, she said.
So far, they've observed clinical responses of up to three years in patients they've treated this way.
"About 85% of 60 patients are quite significantly better, with half able to come off all therapy after about a year," Dr. Terry Bolin, who presented the results, told Reuters Health. Dr. Bolin is at Prince of Wales Hospital, Randwick, New South Wales.
"I sometimes use appendicectomy as first-line therapy, because other treatments take time, are not guaranteed to work, and they're not a lifelong cure as this potentially might be," he said.
Session moderator Dr. Uma Mahadevan-Velayos, from the University of California, San Francisco, told Reuters Health - not surprisingly -- "I think these results obviously have to be taken with caution."
"Doing abdominal surgery is a major intervention, and his comment that it should be first-line therapy is not appropriate, since we have 5-aminosalicylates, which are very low risk and very effective for the majority of patients," she said.
On the other hand, this option may be feasible for a patient with a severe flare for whom colectomy is being considered, she continued. "Just removing their appendix is a better option than removing their colon."
In their meeting abstract, Dr. Bolin and colleagues report on 50 patients with ulcerative proctitis who had appendectomies. (They reported on their first 30 patients last year, in a paper in the American Journal of Gastroenterology.)
The median Simple Clinical Colitis Activity Index improved from 9 to 2 (p < 0.0005) in 40 patients; the other 10 patients had no change. (The maximum score on the Simple Clinical Colitis Activity Index is 15, plus 1 point for every extra-colonic manifestation.)
Thirty-seven patients have had sustained clinical responses. The other three have had flares that responded to medical treatment - whereas prior to surgery, medical treatment was ineffective.
"We can't predict who's going to respond," Dr. Bolin said. None of the factors they've looked at -- age, sex, disease duration, histopathology of the appendix - was related to clinical outcome.
He said he has tried this approach for five patients with more extensive colitis, three of whom "got better." One has been able to go off medication.
"I think this is a very intriguing idea, and there is evidence there may be something here based on population-based studies," said Dr. Mahadevan-Velayos. She noted that "a fairly consistent literature" shows that patients who have an appendectomy early in life are less likely to develop ulcerative colitis later in life, "so there does appear to be a connection between the appendix and ulcerative colitis."
The study's major limitation is the failure to document endoscopically that there was mucosal healing after appendectomy, she said.
