Appendicectomy as a therapy for ulcerative proctitis.
OBJECTIVE
Available data regarding whether appendicectomy performed after the onset of ulcerative colitis can modulate its clinical course are currently limited. This study aimed at addressing this issue.


METHODS
In this study, we report a prospective case series of 30 adult patients (median age 35 years, range 17-70 years; male/female: 11/19) with ulcerative proctitis (median duration of symptoms 5 years, range 8 months to 30 years; median Simple Clinical Colitis Activity Index score 9, range 7-12), who underwent appendicectomy in the absence of any history suggestive of previous appendicitis. Patients were subsequently followed up clinically with the assessment of the Simple Clinical Colitis Activity Index for a median of 14 months (range 9-32 months).


RESULTS
After appendicectomy, the clinical activity index improved significantly to a median score of 2 (range 0-12) (P<0.0005). The improvement in the clinical activity index occurred in 27 of 30 (90%) patients, whereas the index remained unchanged in the remaining 3 of 30 (10%) patients. Furthermore, 12 of 30 (40%) patients experienced a complete resolution of symptoms (clinical activity index score of 0) by 12 months, such that all pharmacological treatments could be withdrawn, and have remained in remission off all previous treatments for a median 9 months (range 6-25 months). The time required for a complete resolution of symptoms post appendicectomy ranged from 1 to 12 months (median 3 months) (Kaplan-Meier analysis). None of the clinical or histological factors analyzed were significantly associated with post-appendicectomy outcome.


CONCLUSIONS
This case series, the largest reported so far, provides rationale for controlled trials to properly evaluate the possible role of appendicectomy in the treatment of ulcerative proctitis.
Bolin
Terry Dorcen
TD
Gastrointestinal and Liver Unit, Department of Medicine, The Prince of Wales Hospital, 201 Avoca Street, Randwick 2031, New South Wales, Sydney 2031, Australia. kerrie@terrybolin.com
Wong
Shing
S
Crouch
Roger
R
Engelman
Jeffrey Lionel
JL
Riordan
Stephen Mark
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000601:surgery*; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome