Аппендэктомия и воспалительные заболевания кишечника – существует ли связь?

Коровин С.А., Оробинский С.Б., Оробинская Я.В.,Соколов Ю.Ю.,Захарова И.Н. Аппендэктомия и воспалительные заболевания кишечника – существует ли связь? Педиатрия. Consilium Medicum. 2024;2:198–203. DOI: 10.26442/26586630.2024.2.202931

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Korovin SA, Orobinsky SB, Orobinskaya YaV, Sokolov YuYu, Zakharova IN. Appendectomy and inflammatory bowel disease: Is there a link? A review. Pediatrics. Consilium Medicum. 2024;2:198–203.
DOI: 10.26442/26586630.2024.2.202931

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Аннотация

Аппендикс исторически считался рудиментарным органом с неизвестной функцией. В настоящее время его роли в человеческом организме отведено особое место. Доказано, что он является «копилкой» для комменсальных микроорганизмов и выполняет роль иммунологического органа. Влияние аппендэктомии на развитие язвенного колита и болезни Крона является предметом дискуссий на протяжении более 30 лет. Сообщается, что удаление червеобразного отростка в раннем возрасте уменьшает риск развития язвенного колита, но приводит к прогрессирующему течению болезни Крона. Эти наблюдения привели к постулату о том, что между аппендэктомией и воспалительными заболеваниями кишечника может существовать взаимосвязь, которую можно объяснить иммуномодулирующим эффектом оперативного вмешательства. До сих пор нет окончательных доказательств защитной или повреждающей роли червеобразного отростка при воспалительных заболеваниях кишечника, что является перспективой для будущих исследований.

Ключевые слова: аппендикс, аппендицит, аппендэктомия, воспалительные заболевания кишечника, микробиом кишечника, микробиота аппендикса

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The appendix has historically been considered a rudimentary organ with an unknown function. Currently, its role in the human body has a special place. It has been proved that it is a "piggy bank" for commensal microorganisms and acts as an immunological organ. The impact of appendectomy on ulcerative colitis and Crohn’s disease has been debated for more than 30 years. Removal of the appendix at an early age has been reported to reduce the risk of ulcerative colitis but lead to a progressive course of Crohn’s disease. These observations led to the postulate that there may be an association between appendectomy and inflammatory bowel disease that can be explained by the immunomodulatory effect of surgery. There is still no definitive evidence of a protective or damaging role of the appendix in inflammatory bowel disease, which is a prospect for future research.

Keywords: appendix, appendicitis, appendectomy, inflammatory bowel disease, gut microbiome, appendix microbiota

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Список литературы

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23. Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg. 2007;245(6):886-92. DOI:10.1097/01.sla.0000256391.05233.aa
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28. Koutroubakis IE, Vlachonikolis IG, Kouroumalis EA. Role of appendicitis and appendectomy in the pathogenesis of ulcerative colitis: a critical review. Inflamm Bowel Dis. 2002;8(4):277-86. DOI:10.1097/00054725-200207000-00007
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1. Britannica, The Editors of Encyclopaedia. “Appendix”. Encyclopedia Britannica, 1 Aug. 2024. Available at: https://www.britannica.com/science/appendix. Accessed: 12.06.2024.
2. Schumpelick V, Dreuw B, Ophoff K, Prescher A. Appendix and cecum. Embryology, anatomy, and surgical applications. Surg Clin North Am. 2000;80(1):295-318.
DOI:10.1016/s0039-6109(05)70407-2
3. Mohammadi S, Hedjazi A, Sajjadian M, et al. Morphological variations of the vermiform appendix in Iranian cadavers: a study fr om developing countries. Folia Morphol (Warsz). 2017;76(4):695-701. DOI:10.5603/FM.a2017.0032
4. Bhangu A, Søreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet.
2015;386(10000):1278-87. DOI:10.1016/S0140-6736(15)00275-5. Erratum in: Lancet. 2017;390(10104):1736. DOI:10.1016/S0140-6736(17)31502-7
5. Gonzalez DO, Deans KJ, Minneci PC. Role of non-operative management in pediatric appendicitis. Semin Pediatr Surg. 2016;25(4):204-7. DOI:10.1053/j.sempedsurg.2016.05.002
6. Shi F, Liu G, Lin Y, et al. Altered gut microbiome composition by appendectomy contributes to colorectal cancer. Oncogene. 2023;42(7):530-40. DOI:10.1038/s41388-022-02569-3
7. Kooij IA, Sahami S, Meijer SL, et al. The immunology of the vermiform appendix: a review of the literature. Clin Exp Immunol. 2016;186(1):1-9. DOI:10.1111/cei.12821
8. Kiasat A, Ekström LD, Marsk R, et al. Childhood appendicitis and future risk of inflammatory bowel disease – A nationwide cohort study in Sweden 1973-2017. Colorectal Dis. 2022;24(8):975-83. DOI:10.1111/codi.16128
9. Fava F, Danese S. Intestinal microbiota in inflammatory bowel disease: friend of foe? World J Gastroenterol. 2011;17(5):557-66. DOI:10.3748/wjg.v17.i5.557
10. Ansaloni L, Catena F, Pinna AD. What is the function of the human vermiform appendix? Evolution-based surgery: a new perspective in the Darwinian year 2009. Eur Surg Res. Europaische Chirurgische Forschung Recherches Chirurgicales Europeennes. 2009;43:67-71. DOI:10.1159/000219236
11. Darwin C. The descent of man, and selection in relation to sex. London, England UK: John Murray. 1871;1:423.
12. Rhee KJ, Sethupathi P, Driks A, et al. Role of commensal bacteria in development of gut-associated lymphoid tissues and preimmune antibody repertoire. J Immunol.
2004;172:1118-24. DOI:10.4049/jimmunol.172.2.1118
13. Hanson NB, Lanning DK. Microbial induction of B and T cell areas in rabbit appendix. Dev Comp Immunol. 2008;32:980-91. DOI:10.1016/j.dci.2008.01.013
14. Vitetta L, Chen J, Clarke S. The vermiform appendix: an immunological organ sustaining a microbiome inoculum. Clin Sci (Lond). 2019;133(1):1-8. DOI:10.1042/CS20180956
15. Vignali DA, Collison LW, Workman CJ. How regulatory T cells work. Nat Rev Immunol. 2008;8:523-32. DOI:10.1038/nri2343
16. Ishimoto Y, Tomiyama-Miyaji C, Watanabe H, et al. Age-dependent variation in the proportion and number of intestinal lymphocyte subsets, especially natural killer T cells, double-positive CD4+ CD8+ cells and B220+ T cells, in mice. Immunology. 2004;113:371-7. DOI:10.1111/j.1365-2567.2004.01961.x
17. Costerton JW, Lewandowski Z, Caldwell DE, et al. Microbial biofilms. Annu Rev Microbiol. 1995;49:711-45. DOI:10.1146/annurev.mi.49.100195.003431
18. Guinane CM, Tadrous A, Fouhy F, et al. Microbial composition of human appendices from patients following appendectomy. mBio. 2013;4(1):e00366-12. DOI:10.1128/mBio.00366-12
19. Rogers MB, Brower-Sinning R, Firek B, et al. Acute Appendicitis in Children is Associated With a Local Expansion of Fusobacteria. Clin Infect Dis. 2016;63(1):71-8. DOI:10.1093/cid/ciw208
20. Vanhatalo S, Munukka E, Sippola S, et al. Prospective multicentre cohort trial on acute appendicitis and microbiota, aetiology and effects of antimicrobial treatment: study protocol for the MAPPAC (Microbiology APPendicitis ACuta) trial. BMJ Open. 2019;9(9):e031137. DOI:10.1136/bmjopen-2019-031137
21. Clanton J, Subichin M, Drolshagen K, et al. Fulminant Clostridium difficile infection: An association with prior appendectomy? World J Gastrointest Surg. 2013;5(8):233-8. DOI:10.4240/wjgs.v5.i8.233
22. Smith HF, Fisher RE, Everett ML, et al. Comparative anatomy and phylogenetic distribution of the mammalian cecal appendix. J Evol Biol. 2009;22(10):1984-99.
DOI:10.1111/j.1420-9101.2009.01809.x
23. Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg. 2007;245(6):886-92. DOI:10.1097/01.sla.0000256391.05233.aa
24. Ferris M, Quan S, Kaplan BS, et al. The Global Incidence of Appendicitis: A Systematic Review of Population-based Studies. Ann Surg. 2017;266(2):237-41. DOI:10.1097/SLA.0000000000002188
25. Andreu-Ballester JC, Pérez-Griera J, Ballester F, et al. Secretory immunoglobulin A (sIgA) deficiency in serum of patients with GALTectomy (appendectomy and tonsillectomy). Clin Immunol. 2007;123(3):289-97. DOI:10.1016/j.clim.2007.02.004
26. Masahata K, Umemoto E, Kayama H, et al. Generation of colonic IgA-secreting cells in the caecal patch. Nat Commun. 2014;5:3704. DOI:10.1038/ncomms4704
27. Cai S, Fan Y, Zhang B, et al. Appendectomy Is Associated With Alteration of Human Gut Bacterial and Fungal Communities. Front Microbiol. 2021;12:724980. DOI:10.3389/fmicb.2021.724980
28. Koutroubakis IE, Vlachonikolis IG, Kouroumalis EA. Role of appendicitis and appendectomy in the pathogenesis of ulcerative colitis: a critical review. Inflamm Bowel Dis. 2002;8(4):277-86. DOI:10.1097/00054725-200207000-00007
29. Andersson RE, Olaison G, Tysk C, Ekbom A. Appendectomy and protection against ulcerative colitis. N Engl J Med. 2001;344(11):808-14. DOI:10.1056/NEJM200103153441104
30. Gecse K, Róka R, Séra T, et al. Leaky gut in patients with diarrhea-predominant irritable bowel syndrome and inactive ulcerative colitis. Digestion. 2012;85(1):40-6. DOI:10.1159/000333083
31. Yokode M, Shiokawa M, Kawakami H, et al. Anti-integrin αvβ6 autoantibodies are a potential biomarker for ulcerative colitis-like immune checkpoint inhibitor-induced colitis. Br J Cancer. 2024;130(9):1552-60. DOI:10.1038/s41416-024-02647-1
32. Barbara G, Barbaro MR, Fuschi D, et al. Inflammatory and Microbiota-Related Regulation of the Intestinal Epithelial Barrier. Front Nutr. 2021;8:718356. DOI:10.3389/fnut.2021.718356. Erratum in: Front Nutr. 2021;8:790387. DOI:10.3389/fnut.2021.790387
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Авторы

С.А. Коровин*^1,2, С.Б. Оробинский², Я.В. Оробинская^1,3, Ю.Ю. Соколов^1,4, И.Н. Захарова¹

¹ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
²ГБУЗ «Детская городская клиническая больница им. З.А. Башляевой» Департамента здравоохранения г. Москвы, Москва, Россия;
³ГБУЗ МО «Химкинская больница», Химки, Россия;
⁴ФГБУ «Центральная клиническая больница с поликлиникой» Управления делами Президента РФ, Москва
*korovinsa@mail.ru

________________________________________________

Sergey A. Korovin*^1,2, Sergey B. Orobinsky², Yana V. Orobinskaya^1,3, Yurij Yu. Sokolov^1,4, Irina N. Zakharova¹

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
²Bashlyaeva Children's City Clinical Hospital, Moscow, Russia;
³Khimki Hospital, Khimki, Russia
⁴Central Clinical Hospital with a Polyclinic, Moscow, Russia
*korovinsa@mail.ru

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