Although the incidence of appendicitis in the United States has been declining for many years, the condition continues to affect approximately seven percent of Americans annually. And for researchers studying the organ, new questions arise about how the environment, lifestyle or genetics of this small cohort of patients could predispose them to appendicitis even when it becomes less common.
Researchers from the Faculty of Medicine and Sciences of the UND (SMHS) are also exploring these questions and seeking novel answers.
"Several of my patients had colonoscopies from different providers, then I saw these patients and they had appendicitis, a few days after the colonoscopy," explained Dr. Marc D. Basson, associate senior dean of Medicine and Research of the Faculty of Medicine and Health Sciences of UND. "And the patient asks something like," My God, the colonoscopist did something wrong, why do I have appendicitis now? "But since both colonoscopy and appendicitis are common things, the question was: Is there a real correlation here, or are these two random events that just happened together by chance? "
To answer that question, Basson and a team of colleagues, including Dr. William P. Newman, president emeritus of the Department of Internal Medicine at SMHS, and Dr. Daniel Persinger, a surgical resident at the time of the research and currently a junior faculty member of SMHS in surgery, put to work.
The result of that work was the article "Colonoscopy is associated with an increased risk of appendicitis", published in October by JAMA Surgery the surgical branch of Journal of the American Medical Association .
As it turns out, writes Basson's team, there is evidence suggesting that colonoscopy may "cause" appendicitis up to a week after colonoscopy, at least in Cer The conclusion was necessary to access a large amount of data with the order to achieve statistical significance. Basson and his team turned to the Veterans Administration Health System of Fargo (VA) to access national Veterans Administration data, which identified nearly 400,000 veterans in the United States who had had a screening colonoscopy in January. 2009 and June 2014, and whose incidence of subsequent procedures could be traced.
"Depending on how you ask the question, it turns out that the rate of appendicitis and appendectomy in the first week after a colonoscopy was at least four times higher compared to the following 51 weeks of these patients," Basson added, noting that the investigation explains the differences in the codification of procedures and other discrepancies in the administrative data. "In some measures, the increase was 12 times."
Although the reasons why colonoscopy increases the risk of appendicitis remain unclear, the article offers some theories, which include asking whether bacteria within the colon are altered as the bowel is prepared before the colonoscopy of the colon. ways that increase the likelihood of inflammation, or if the increased air pressure caused by colonoscopy may have effects on the colonic mucosa that may predispose people to appendicitis.
Do not omit the scope
Despite the significant findings of the article, Basson urged patients not to draw the wrong conclusions: "To be clear, this does not mean that colonoscopy does not it is safe or that people should be afraid to undergo the procedure.Colonoscopy is valuable and the rate of appendicitis is still very, very low, so low that we would not even have been able to define this increased risk without this huge data set ", he explained. "But it's good to know that this is real, because this was not known before.This opens up a new area of research, and now we can start asking questions about why this happens.In addition, we can now have a higher index of suspected appendicitis in patients with pain in the lower right part of the abdomen after colonoscopy, which can lead to earlier diagnoses. "
The final result of this study, says Dr. Basson, is that researchers have more work to do.
"My hope is that this study will stimulate more conversation, more studies, so we can learn more about all this," he concludes. "Clearly, there is more biological activity with the appendix than we thought there were 100 years ago."