The ACCURE randomised clinical trial investigated whether laparoscopic appendicectomy could improve disease outcomes in ulcerative colitis (UC) when added to standard medical therapy. The rationale for this approach stems from evidence suggesting that the appendix may play an immunomodulatory role in UC, influencing intestinal inflammation and disease relapse.
The ACCURE randomised clinical trial investigated whether laparoscopic appendicectomy could improve disease outcomes in ulcerative colitis (UC) when added to standard medical therapy. The rationale for this approach stems from evidence suggesting that the appendix may play an immunomodulatory role in UC, influencing intestinal inflammation and disease relapse.
In this multicentre international randomised trial conducted across the Netherlands, Ireland, and the UK, patients with established UC in remission but with a relapse within the previous year were assigned to either:
Appendicectomy plus maintenance medical therapy, or
Medical therapy alone.
After 12 months of follow-up, the appendicectomy group demonstrated significantly better outcomes:
Relapse rate: 36% after appendicectomy vs 56% with medical therapy alone.
Relative risk reduction: about 35% lower relapse risk.
Patients undergoing appendicectomy were also less likely to require escalation to biologic therapy and had improved quality-of-life measures.
The procedure was generally safe, with only a small number of postoperative complications and no deaths reported.
Key Clinical Message
This landmark study provides the first randomised evidence that appendicectomy can reduce relapse rates in ulcerative colitis when added to standard therapy. It suggests that the appendix may contribute to UC pathogenesis and that appendicectomy could become an adjunctive therapeutic strategy, particularly in patients with recurrent disease despite conventional therapy.
Introduction: The global incidence of inflammatory bowel disease (IBD) continues to rise, particularly in newly industrialized countries. This comprehensive systematic review evaluated how race, ethnicity, geography, and migration influence the clinical phenotype and outcomes of...
Introduction: Acute severe ulcerative colitis (ASUC) remains one of the most life-threatening emergencies in inflammatory bowel disease. Despite advances in IBD therapy, first-line management has changed little over the past two decades, and colectomy continues...
Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease with a rising global burden. Although current therapies are effective, many patients fail treatment or experience adverse effects. Fecal microbiota transplantation (FMT) has emerged as...
Introduction: Despite major advances with biologics and small molecules, many patients with IBD continue to have refractory disease or lose treatment response. This Perspective explores engineered cellular therapies designed to restore immune tolerance rather than...
Introduction: Randomized clinical trials (RCTs) are the cornerstone for approving biologic therapies in inflammatory bowel disease (IBD). However, strict eligibility criteria may exclude many patients encountered in routine clinical practice, raising concerns about the real-world...
Introduction: Mirikizumab, a selective IL-23p19 inhibitor, has demonstrated efficacy in phase III clinical trials for moderate-to-severe ulcerative colitis (UC). This multicenter Italian real-world study evaluated its effectiveness and safety in routine clinical practice, including patients...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.