Appendicectomy Reduces Relapse in Ulcerative Colitis: ACCURE Trial.
A New Surgical Option to Maintain Ulcerative Colitis Remission
A groundbreaking international study—the ACCURE trial—has revealed that laparoscopic appendicectomy significantly reduces relapse rates in patients with ulcerative colitis (UC) who are in remission. Published in The Lancet Gastroenterology & Hepatology on April 11, 2025, these findings suggest that appendix removal, alongside standard medical therapy, could offer a promising adjunct treatment for this chronic inflammatory bowel disease.
The Appendix and Its Role in Ulcerative Colitis
Why the Appendix Matters in Inflammatory Bowel Disease
Ulcerative colitis, affecting over 5 million people worldwide, is a relapsing-remitting disease that causes inflammation of the colon’s mucosal lining. The appendix—once thought to be a vestigial organ—has recently been identified as a key player in immune modulation, possibly influencing UC’s disease course through cytokine production and microbial interactions.
Previous Evidence Linking Appendicectomy and Colitis Risk Reduction
As early as 1987, observational studies suggested that people who had undergone appendicectomy had a lower risk of developing UC. A 2016 meta-analysis reported an odds ratio of 0.39, indicating a substantial protective effect. However, until now, no randomized controlled trial had confirmed whether removing the appendix could maintain remission in established UC patients.
The ACCURE Trial: Design and Methods
Study Design and Patient Selection
Conducted across 22 centers in the Netherlands, Ireland, and the UK, the ACCURE trial randomly assigned 197 patients with UC in remission—but who had relapsed in the prior year—to two groups: one received laparoscopic appendicectomy plus standard medical therapy, and the other continued medical therapy alone.
Primary Outcome and Safety Measures
The trial’s primary endpoint was disease relapse within one year, defined using the Mayo scoring system and additional clinical markers. Adverse events and overall safety were rigorously monitored.
Key Results and Clinical Outcomes
Appendix Removal Significantly Lowers Relapse Risk
Results showed a 1-year relapse rate of 36% in the appendicectomy group compared to 56% in the medical therapy group—representing a 35% relative risk reduction (p=0.005). This robust finding confirms the clinical efficacy of appendicectomy as a remission-maintaining intervention.
Adverse Events and Safety Profile
Adverse events were comparable between groups (11% vs 10%), with no deaths reported. Notably, incidental low-grade appendiceal neoplasms were discovered in 2% of appendicectomy patients, though without clinical consequence.
Implications for Clinical Practice
Could Appendicectomy Become a Standard UC Treatment?
The ACCURE trial paves the way for considering appendicectomy as a valid option to complement medical therapy in UC management, particularly for patients prone to frequent relapses.
Benefits of Combining Surgery With Medical Therapy
Laparoscopic appendicectomy is minimally invasive and appears to offer durable protection when paired with existing medications like mesalazine and immunosuppressants.
Considerations for Patients and Physicians
Careful patient selection and shared decision-making will be critical as clinicians weigh surgical risks, individual relapse patterns, and patient preferences.
Conclusion
Appendicectomy: A Promising Adjunct to Prevent Colitis Relapse
For patients struggling to maintain remission in ulcerative colitis, appendicectomy represents a novel, evidence-backed addition to the treatment arsenal, offering hope for longer-lasting relief and improved quality of life.