Health Rounds: Appendectomy appears to reduce ulcerative colitis relapses
Patients with the chronic inflammatory bowel disease ulcerative colitis might reduce their risk of a relapse by having their appendix removed, a new study suggests.
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Ulcerative colitis causes inflammation and ulcers in the large intestine and rectum, with diarrhea and abdominal pain. There is no cure. Symptoms repeatedly subside and relapse and can adversely affect quality of life.
The appendix is thought to play a role in all of this by producing inflammatory proteins that trigger the body to produce cascades of immune responses, according to a report of the study published in The Lancet Gastroenterology & Hepatology, opens new tab.
All 197 adult patients in the current study were in remission at the start but had required treatment for an episode of active disease during the previous year.
All of them received the usual standard care. Half also had an appendectomy.
A year later, the relapse rates were 36% in the appendectomy group and 56% in the usual-care group, the researchers said.
In addition, fewer patients in the appendectomy group later developed more severe disease requiring treatment with biological agents.
There were five postoperative complications in the surgery group, including two that were labeled serious.
After accounting for patients' individual risk factors, the odds of relapse during the study were 35% lower with appendectomy.
'This significant... reduction suggests that appendectomy might be a viable additional therapeutic option for maintaining remission in ulcerative colitis,' the researchers wrote.
'Furthermore, patients who underwent appendectomy were significantly more likely to maintain lower disease activity, reduce the initiation of biological agents, and improve health-related quality of life compared with patients who received standard medical therapy alone.'
An editorial, opens new tab published with the study notes that a separate trial, still underway, is testing the benefit of appendectomy in patients whose ulcerative colitis is not in remission.
GSK ANTIBIOTIC SHOWS PROMISE FOR GONORRHEA
GSK's (GSK.L), opens new tab new pill for uncomplicated urinary tract infections in women and girls is also showing promise for treating uncomplicated gonorrhea, the company reported on Monday in The Lancet, opens new tab.
Gepotidacin, sold as Blujepa, is a first-in-class triazaacenaphthylene antibiotic that acts by inhibiting bacteria's replication of DNA.
In a late-stage, multi-nation trial, researchers randomly assigned 628 patients with gonorrhea in the urinary tract or genitals to treatment with gepotidacin or ceftriaxone with azithromycin.
Success rates at eradicating Neisseria gonorrhoeae bacteria were statistically similar, at 92.6% with gepotidacin and 91.2% with ceftriaxone plus azithromycin.
The gepotidacin group had higher rates of drug-related gastrointestinal adverse side effects, but almost all were mild or moderate, according to the researchers.
An editorial, opens new tab published with the report notes that no new antimicrobials have been introduced for gonorrhoea treatment since the 1990s.
The authors of the editorial expect N. gonorrhoeae to eventually develop resistance to gepotidacin, too.
However, they said gepotidacin should also be tested in patients with gonorrhea of the mouth and throat, which is harder to treat than the urogenital infections seen in the current trial.
An editorial in The Lancet Infectious Diseases, opens new tab notes that in a separate late-stage study, the first-in-class spiropyrimidinetrione antibiotic zoliflodacin was just as effective against urogenital gonorrhea as ceftriaxone plus azithromycin.
Zoliflodacin is being developed as part of a public-private partnership between Innoviva's (INVA.O), opens new tab specialty therapeutics unit and the Global Antibiotic Research & Development Partnership.
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