Research Spotlight: Antibiotics, not surgery, may provide better treatment for appendicitis

Antibiotics rather than surgery may be the better treatment for cases of appendicitis in which the appendix hasn’t burst, according to a new study.

The study’s authors say the findings suggest that nonperforating appendicitis, as the disease is called when the appendix hasn’t burst, may be unrelated to perforating appendicitis, in which the appendix has burst. Instead, the study found that nonperforating childhood appendicitis, which historically has been treated with emergency surgery, seems to be a disease similar to nonperforating adult diverticulitis, which is often treated with antibiotics.

The study, “Epidemiological similarities between appendicitis and diverticulitis suggesting a common underlying pathogenesis,” was reported in the Archives of Surgery.

Childhood appendicitis and adult diverticulitis share many similarities, including association with colon hygiene and a low intake of fiber in the diet. Those shared epidemiological features prompted researchers to examine whether the two might be similar, according to SMU economist Tom Fomby.

“We used a technique called cointegration to investigate common movements in epidemiologic data series,” said Fomby, a professor in SMU’s Department of Economics, who led the statistical analysis with statistician Wayne A. Woodward, professor and department chair in SMU’s Department of Statistical Science.

Lead author on the study was Edward H. Livingston, M.D., in the division of Gastrointestinal and Endocrine Surgery at University of Texas Southwestern Medical School, Dallas; with the Department of Surgery, Veterans Affairs Medical Center Dallas; and in the Department of Bioengineering, University of Texas at Arlington. Also co-authoring was Robert W. Haley, M.D., in the Department of Internal Medicine-Epidemiology, UT Southwestern Medical School, and a past recipient of the SMU Distinguished Alumni Award.

The study looked at 27 years of data from the National Hospital Discharge Survey, which is compiled annually by the Centers for Disease Control and Prevention. The analysis specifically compared national data and regional data for children with appendicitis and adults with diverticulitis who were admitted to U.S. hospitals between 1979 and 2006.

The authors’ analysis shows that although the annual incidence rates of adult nonperforating diverticulitis and child nonperforating appendicitis changed greatly during the past 25 years, their secular patterns – long-term trends – followed the same general patterns, overall as well as region by region, according to the authors.

Appendicitis is a painful infection caused by blockage in the appendix, a fingerlike pouch jutting from the large intestine. It typically affects younger people, age 10 to 30, and is the No. 1 cause of emergency abdominal surgeries, according to the National Digestive Diseases Information Clearinghouse within the National Institutes of Health.

Diverticulitis, which is more common among people older than 60, occurs when pouches that have developed in the lining of the gastrointestinal tract become inflamed and sometimes infected, according to NDDIC. It is often treated with antibiotics, the authors say.

“These findings seem incompatible with the long-held view that perforating appendicitis is merely the progression of nonperforating disease where surgical intervention was delayed too long,” write the authors. “If perforating appendicitis was simply a manifestation of nonperforating appendicitis not treated in a timely manner, the secular trends should have been statistically similar, which they were not.”

Written by Margaret Allen

> Read the full story at the SMU Research blog

About Kathleen Tibbetts

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