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APPENDICECTOMY, PRIMARY SCLEROSING CHOLANGITIS (PSC) and ULCERATIVE COLITIS (UC)
Author(s) -
Florin Timothy,
Cayzer Catherine,
Purdie David,
Fawcett Jonathan,
RadfordSmith Graham
Publication year - 2001
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2001.ca01-11.x
Subject(s) - medicine , ulcerative colitis , primary sclerosing cholangitis , pancolitis , inflammatory bowel disease , gastroenterology , population , appendix , colectomy , immune system , colitis , immunology , disease , colonoscopy , colorectal cancer , paleontology , environmental health , cancer , biology
The relationship between PSC and inflammatory bowel disases (IBD) remains largely unexplained. The most usual IBD phenotype reported with PSC is clinically mild UC pancolitis. Primary sclerosing cholangitis is not improved by colectomy (+ contemporaneous appendicectomy). We have shown that appendicectomy has a strong negative association with UC and a more benign UC phenotype. In animal models, early appendicectomy results in a significant reduction in mucosal Ig production, and in models of colitis the same early intervention protects the animal from the disease. The human appendix has a large complement of activated B cells which may seed the intestine with IgA‐secreting plasma cells in a similar way to these models. IgA will exclude bacteria from the gut epithelium. If there is impaired IgA‐mediated bacterial exclusion, then there may be not only a diluted intestinal mucosal immune response but an increased bacterial load in the portal circulation that requires a second‐line immune response by the liver. Thus, removal of an appendix in patients who are susceptible to UC may predispose to a more benign UC phenotype and PSC. Hypothesis Appendicectomy is associated with PSC. Materials and methods Review the Brisbane IBD database and interrogation of the Brisbane PSC transplant patient database for appendicectomy, age at surgery, age at diagnosis of UC and PSC, disease phenotype, smoking status (known to influence UC). Appendicectomy prevalence compared with age‐ and cohort‐matched controls randomly selected from a large population‐based twin registry (one twin selected from each pair). At this stage, the control population has been age‐ and cohort‐matched to the Brisbane IBD database only. Results The frequency of appendicectomy in patients with PSC prior to diagnosis of either the PSC or IBD is 17 of 67 (25.4%). This is significantly higher than the appendicectomy rate in UC alone 19 of 300 (6.3%), Fisher's exact test, P < 0.0001. The 25.4% rate in PSC is similar to the controls, 235 of 897 (26%), P = 1.0. Conclusions The preliminary data support the hypothesis that appendicectomy is more likely in UC patients with PSC. Reported prevalences of appendicectomy in PSC vs. UC without PSC (Erpecum, Gastroenterology 2000, 110:1503 and Griffin & Selby JGH 1999 Supp A121) support our findings. The appendicectomy prevalence may not be different from a matched control population. Further analysis controlling for smoking habit and a control group matched with the combined databases are ongoing.