[Appendectomy as a disease-modifying therapy in ulcerative colitis?]

Ulcerative colitis is a chronic inflammatory systemic disease with rising incidence and increased mortality. Despite established therapeutic strategies, particularly maintenance therapy with mesalazine, approximately one third of patients experience a relapse within one year. Epidemiological studies demonstrate an inverse association between prior appendectomy and the risk of developing the disease, suggesting an immunological role of the appendix. Against this background, appendectomy has been investigated as a potential disease-modifying approach. The randomized ACCURE trial demonstrated a significant reduction in the one-year relapse rate with adjunctive appendectomy in the maintenance setting (36% vs. 56%; relative risk 0.65; NNT = 5), with a favorable safety profile. In patients with active disease under advanced therapy, the non-randomized COSTA study showed higher rates of steroid-free remission after appendectomy compared with switching to a JAK inhibitor, although no difference in colectomy rates was observed. In the PASSION study of therapy-refractory disease, 30% achieved a clinical response; histologically inflamed appendices were predictive of therapeutic success. In summary, randomized evidence currently exists only for the maintenance setting. Appendectomy appears to be a low-risk, potentially additive strategy for selected patients, but further controlled studies with long-term follow-up and biomarker stratification are required.