Appendix Removal With Therapy May Help Maintain UC Remission

TOPLINE:

Among patients with ulcerative colitis in remission who had been treated for a disease relapse, those who underwent laparoscopic appendicectomy combined with standard medical therapy had lower relapse rates at 1 year than those who received standard treatment alone.

METHODOLOGY:

• Researchers conducted a pragmatic randomised controlled superiority trial (2012-2022) at 22 centres in the Netherlands, Ireland, and the United Kingdom to assess the clinical effectiveness of laparoscopic appendicectomy in maintaining remission in patients with ulcerative colitis.
• They included adult patients with confirmed ulcerative colitis who were in remission (defined as a Mayo score ≤ 2, with subscores of 0 or 1 for stool frequency, rectal bleeding, and physician’s assessment, confirmed by an endoscopic score of 0 or 1 or faecal calprotectin levels < 150 μg/g) but who had required treatment for an episode of active disease in the past 12 months.
• The patients were randomly assigned to undergo laparoscopic appendicectomy with standard medical therapy (appendicectomy group; n = 99; mean age, 42.2 years; 57% women) or to continue standard medical treatment alone (control group; n = 98; mean age, 43.2 years; 56% women). Most patients used oral mesalazine as maintenance therapy.
• The primary outcome was the proportion of patients with disease relapse within 1 year, with relapse defined by a total Mayo score ≥ 5 and an endoscopic subscore of 2 or 3, exacerbation of abdominal symptoms, an increased rectal bleeding subscore, faecal calprotectin levels > 150 μg/g, or the need for treatment intensification.

TAKEAWAY:

• The relapse rate at 1 year was lower in the appendicectomy group than in the control group (36% vs 56%; relative risk, 0.65; adjusted P = .002).
• The median time to first relapse was 50.57 weeks in the control group but was not reached in the appendicectomy group (hazard ratio for relapse, 0.54; P = .003).
• Initiation of biologic agents was less frequent in the appendicectomy group than in the control group (odds ratio, 0.003; P = .01), and both groups showed a decreased use of oral mesalazine.
• The total score and bowel symptom domain score of the Inflammatory Bowel Disease Questionnaire, reflecting health-related quality of life, improved in the appendicectomy group compared with the control group. Adverse events were reported in 11% of patients in the appendicectomy group and 10% of patients in the control group, with no deaths reported in either group.

IN PRACTICE:

“Appendicectomy is a viable and safe strategy for reducing the relapse rate in patients with ulcerative colitis compared with standard medical therapy at 1 year, offering a potential addition to standard medical therapies,” the authors concluded.

“These findings suggest that the appendix might not only influence ulcerative colitis inflammation but could also serve as a therapeutic target,” authors of an accompanying commentary wrote.

SOURCE:

This study, led by Eva Visser, MD, from the University of Amsterdam, Amsterdam, the Netherlands, was published online on April 11, 2025, in The Lancet Gastroenterology & Hepatology.

LIMITATIONS:

The absence of a sham-surgery control group may have introduced bias in the readouts of health-related quality-of-life measurements. Participation bias may have been present, as only patients in remission who were willing to undergo an additional surgery were included. Not all patients received follow-up endoscopy to objectively determine relapse.

DISCLOSURES:

This study was funded by Fonds Nuts-Ohra and the National Institute for Health Research (NIHR) Efficacy and Mechanism Evaluation. Several authors reported receiving speaker fees, presentation or lecture fees, research funding, travel support, or honoraria from multiple agencies, including pharmaceutical and healthcare companies, as well as the NIHR. Additionally, some authors reported serving on advisory boards for these agencies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.