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The Link between the Appendix and Ulcerative Colitis: Clinical Relevance and Potential Immunological Mechanisms

Sahami, S MD, MSc1; Kooij, I A BSc2; Meijer, S L MD, PhD3; Van den Brink, G R MD, PhD2,4; Buskens, C J MD, PhD1; te Velde, A A PhD2

American Journal of Gastroenterology: February 2016 - Volume 111 - Issue 2 - p 163–169
doi: 10.1038/ajg.2015.301
THE RED SECTION: POINT-COUNTERPOINT
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The human appendix has long been considered as a vestigial organ, an organ that has lost its function during evolution. In recent years, however, reports have emerged that link the appendix to numerous immunological functions in humans. Evidence has been presented for an important role of the appendix in maintaining intestinal health. This theory suggests that the appendix may be a reservoir or ‘safe house’ from which the commensal gut flora can rapidly be reestablished if it is eradicated from the colon. However, the appendix may also have a role in the development of inflammatory bowel disease (IBD). Several large epidemiological cohort studies have demonstrated the preventive effect of appendectomy on the development of ulcerative colitis, a finding that has been confirmed in murine colitis models. In addition, current studies are examining the possible therapeutic effect of an appendectomy to modulate disease course in patients with ulcerative colitis. This literature review assesses the current knowledge about the clinical and immunological aspects of the vermiform appendix in IBD and suggests that the idea of the appendix as a vestigial remnant should be discarded.

1Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands

2Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, The Netherlands

3Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands

4Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

Correspondence: Anje A. te Velde, PhD, Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Meibergdreef 69-71, S building, 1105 BK, Amsterdam 1105AZ, The Netherlands. E-mail: a.a.tevelde@amc.uva.nl

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A414

Received 13 January 2015; accepted 11 August 2015

Guarantor of the article: Anje A. te Velde, PhD.

Specific author contributions: S.S. collected the data and drafted the manuscript, and approved the final draft of the manuscript; I.A.K. collected the data and drafted the manuscript, and approved the final draft of the manuscript; S.L.M. reviewed the manuscript and approved the final draft of the manuscript; G.R.V. reviewed the manuscript and approved the final draft of the manuscript; C.J.B. planned the study, and reviewed and approved the final draft of the manuscript; A.A.tV. planned the study, and reviewed and approved the final draft of the manuscript.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2016. All Rights Reserved.
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