Goodbye, Appendix. Hello, Crohn’s Disease?

— Meta-analysis discovers a possible connection, although high heterogeneity was a problem

by
Ed SusmanContributing Writer, MedPage Today
December 17, 2023

ORLANDO– People who go through appendectomy might have an increased danger for the advancement of Crohn’s illness (CD), however not ulcerative colitis (UC), according to an organized evaluation and meta-analysis.

The meta-analysis revealed a pooled OR of 1.57 (95% CI 1.01-2.43, P< 0.00001) for CD in those who had actually gotten surgical treatment of the mucosa-and-gut lymphoid tissue (MALT/GALT), reported Suprada Vinyak, MD, of Ballad Health in Norton, Virginia, at the Advances in Inflammatory Bowel Diseases yearly conference. Vinyak and associates warned in their poster that “significant heterogeneity was observed (93%).”

In much better news, there was a 40% decrease in danger for UC following MALT surgical treatment (pooled OR 0.60, 95% CI 0.24-1.57, P< 0.00001), they reported, although when again, there was a high level of heterogeneity (96%). Vinyak called the finding "unexpected. To be sincere, I can't discuss it. We were anticipating both CD and UC to be connected with appendectomy."

Daniel Waintraub, MD, of the Gastro Health Boca Raton and West Boca Medical Center in Florida, described to MedPage Today that “oftentimes, when individuals have actually imaging provided for an IBD work-up, they [clinicians] will see swelling in the ideal colon where the appendix is. In some cases cosmetic surgeons who are getting ready for an appendectomy will see in their work-up some concomitant swelling in the cecum where Crohn’s emerges.”

“It is possible these are incidental findings, however to state what precedes– appendectomy or CD– is still an open concern,” he stated.

Waintraub, who was not associated with the research study, stated that “I have actually constantly thought about the appendix as a vestigial organ that truly does not do anything in the body, however possibly this details might reveal otherwise. This is fascinating work, and definitely recommends we require more research studies in this location.”

Vinyak informed MedPage Today that “we got thinking about this when we recognized that with a number of our clients with CD or with UC, the common measure was an appendectomy. We chose to look into this by doing medical literature searches.”

The scientists discussed that MALT/GALT “play a critical function in immune guideline and gut microbiota balance. While dysbiosis [an imbalance in the gut microbiome] has actually been reported in IBD clients, a direct association stays uncertain.”

They looked for appendectomies, MALT surgical treatments, and IBD, eventually deciding on 23 observational research studies and 6 top-level evidentiary research studies for the meta-analysis.

Vinyak stated that the findings will add to a much better understanding of the links in between MALT surgical treatment and IBD. She explained that “there are a number of unanswered concerns. We do not understand from this research study whether appendectomy preceded CD or vice versa, although that is something we are checking out in additional work. We are likewise attempting to exercise the systems of action that would trigger one or the other.”