Diagnostic evaluation of appendiceal orifice inflammation in ulcerative colitis

Zhan, Da Qin; Chen, Xing; Wang, Rong; Zhang, Jing; Zhao, Dan; Zhang, Shu Jing; Wang, Zhi Feng; Rui, Jun; Hou, Bo

doi:10.5152/tjg.2016.16215

Cited by 7 publications

(12 citation statements)

References 18 publications

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“… 7 Moreover, a large cohort study found that combining proctitis and AOI features could improve UC diagnosis and facilitate physicians to identify this disorder among various conditions. 16 Furthermore, the current study found that UC patients with AOI developed less severe disease than those without, as reflected by lower modified Mayo scores, and these findings were supported by previous reports. 8 9 Skip lesions were previously thought only to be characteristic of Crohn’s disease.…”

Section: Discussionsupporting

confidence: 91%

“…In alignment with these findings, AOI was considered to precede UC development, suggesting its potential for UC diagnosis 7. Moreover, a large cohort study found that combining proctitis and AOI features could improve UC diagnosis and facilitate physicians to identify this disorder among various conditions 16. Furthermore, the current study found that UC patients with AOI developed less severe disease than those without, as reflected by lower modified Mayo scores, and these findings were supported by previous reports 8 9.…”

Section: Discussionsupporting

confidence: 86%

“…The presence of AOI has been reported in UC patients, and its significance in UC has been investigated. However, the results are controversial 1 6–9 14–16. In this study, the significance of AOI in UC diagnosis and prognosis was prospectively studied.…”

Section: Discussionmentioning

confidence: 95%

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Significance of diagnosis and prognosis for appendiceal orifice inflammation in ulcerative colitis: a real-world study

et al. 2022

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ObjectiveUlcerative colitis (UC) is a chronic inflammatory disease of the large intestine. At present, the significance of appendiceal orifice inflammation (AOI) in UC prognosis is still controversial. This prospective observational study investigated the importance of AOI in UC diagnosis and prognosis. Additionally, it compared the therapeutic efficacy of treatments in UC patients with or without AOI.DesignThis study was a prospective, observational, single-centre, real-world study. Patients with AOI were included in the observation group, and patients without AOI were assigned to the control group. All patients were followed up for 1 year; the disease remission and treatment efficacy were re-examined by colonoscopy. In addition, the clinical, endoscopic and pathological features were collected before and after the treatment.ResultsPatients with endoscopic diffuse inflammatory changes in the distal colorectum accompanied by AOI had a higher positive UC diagnosis rate than those without (96.5% vs 78.0%). Also, AOI had a specificity of 95.2% and a sensitivity of 28.3% for UC diagnosis. However, no difference in the modified Mayo score (p=0.881) or Baron grading was observed between the control and observation groups, indicating that AOI does not affect the treatment outcome of UC patients.ConclusionIn this study, the observation of AOI improved the UC diagnostic accuracy in patients with diffuse lesions in the distal colorectum. Furthermore, the presence of AOI does not affect the treatment efficacies of UC.Trial registration numberChiCTR1800017753.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

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Significance of diagnosis and prognosis for appendiceal orifice inflammation in ulcerative colitis: a real-world study

et al. 2022

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“…Including the largest studies that focused on distal colitis only (as opposed to pancolitis), the most published prevalence rates range between 4.8% and 27.4%. 29,30,35,37,39,40,[43][44][45][46][52][53][54][55] The rate of cecal and/or periappendiceal patch among patients with left-sided colitis is 19.0% in our study, which falls in the middle of this range. However, prior studies had relied on endoscopic identification of the patch only or had not explicitly commented on the inflammation status of ascending colon mucosa.…”

Section: Discussionmentioning

confidence: 81%

Characteristics and Outcomes of Left-sided Ulcerative Colitis With a Cecal/Periappendiceal Patch of Inflammation

Albayrak¹,

Polydorides²

2022

American Journal of Surgical Pathology

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Ulcerative colitis (UC) is characterized by continuous mucosal inflammation of the rectum, extending uninterrupted to a variable portion of the colon proximally. However, in some patients with distal colitis, a distinct pattern of skip inflammation (so-called patch) involves the cecum and/or appendiceal orifice, but data on this entity are contradictory, and its significance and prognosis are still debated. We identified 102 adult cases of left-sided UC with a cecal/periappendiceal patch and compared them to 102 controls (left-sided UC only) along clinicopathologic characteristics and disease outcomes. In multivariate analysis, patients with a patch were younger (median age: 31 vs. 41 y; P=0.004) and more likely to have rectosigmoid involvement only (58.8% vs. 28.4%; P<0.001), compared with patients without a patch. During follow-up, patients with a patch were more likely to be eventually diagnosed with Crohn disease (CD) (9.8% vs. 1.0%; P=0.022) and to show proximal extension of inflammation (35.6% vs. 10.0%; P=0.021), but showed no differences in rates of neoplasia, colectomy, or pharmacotherapy escalation. Kaplan-Meier analysis confirmed that patients with a biopsy diagnosis of cecal/periappendiceal patch were more likely to show proximal disease extension (P<0.001) and to be diagnosed with CD (P=0.008). In conclusion, cecal/periappendiceal skip inflammation in left-sided UC occurs more often in younger patients and in those with rectosigmoid involvement and is associated with proximal disease extension and, in a small fraction of cases, change of diagnosis to CD. However, it does not portend increased risk of neoplasia, pharmacotherapy escalation, or subsequent colectomy, compared with patients with left-sided UC only.

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“…AOI is more frequently observed in UC than in other colitis. It could lead to an effective diagnosis of UC when it is combined with proctitis [ 2 ]. The reported prevalence of AOI ranges from 7.9–75.0% in UC patients observed endoscopically [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical significance and long-term prognosis of ulcerative colitis patients with appendiceal orifice inflammation

et al. 2022

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Background Appendiceal orifice inflammation (AOI) or peri-appendiceal red patch is a skip lesion with segments of continuous colitis from the rectum. Frequently observed in ulcerative colitis (UC) patients, this lesion might be associated with proximal extension in some studies. However, the clinical significance of this lesion and long-term outcomes including therapy remain unclear. Thus, the aim of this study was to evaluate the clinical implication of AOI during long-term periods in patients with UC. Methods We retrospectively reviewed 376 patients with UC who performed complete colonoscopic examinations between April 2000 and December 2020. We compared clinical characteristics and outcomes of patients manifesting AOI with those who did not show AOI during a mean follow-up period of 66.1 months. Long-term outcomes included maximal extent of colitis, proximal extension, therapeutic medical histories, UC-related hospitalization, and relapse. Results Ninety-eight (26.1%) patients showed AOI without evidence of inflammation in the right colon. Mild disease activity at the diagnosis of UC was more included in patients with AOI than in those without AOI. Other baseline characteristics including disease extent, smoking history, external intestinal manifestation, and terminal ileal ulceration were not significantly different between the two groups. During follow-up periods, patients with and without AOI showed no significant difference in proximal extension, Mayo endoscopic score at the last endoscopic examination, UC-related hospitalization, or relapse. Of medication history, patients with AOI were less included in the group treated with high-dose aminosalicylates than those without AOI. However, therapeutic histories of steroids, immunosuppressive agents, and biologics were not significantly different. Of 62 patients with AOI who underwent follow-up colonoscopy, 36 (58.1%) showed resolution of AOI. Clinical outcomes of the resolution group were not different than those of the non-resolution group. Biopsy results of 77 patients with AOI showed chronic active or erosive colitis. Conclusions Long-term outcomes of UC patients with AOI were not different from those without AOI. Outcomes of resolution and non-resolution groups of AOI patients were not different either. Thus, AOI might have no prognostic implication in distal UC patients.

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Diagnostic evaluation of appendiceal orifice inflammation in ulcerative colitis

Cited by 7 publications

References 18 publications

Significance of diagnosis and prognosis for appendiceal orifice inflammation in ulcerative colitis: a real-world study

Significance of diagnosis and prognosis for appendiceal orifice inflammation in ulcerative colitis: a real-world study

Characteristics and Outcomes of Left-sided Ulcerative Colitis With a Cecal/Periappendiceal Patch of Inflammation

Clinical significance and long-term prognosis of ulcerative colitis patients with appendiceal orifice inflammation

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