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O valor da apendicectomia na colite ulcerosa
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A Colite Ulcerosa (CU) é uma doença crónica inflamatória intestinal confinada à camada mucosa do colon, que remite e recidiva de forma cíclica até à colectomia – estado terminal da doença. Apesar da sua etiologia ainda se manter incerta, acredita-se que esta dependa de uma multiplicidade de fatores genéticos e ambientais. Por outro lado, antecedentes pessoais de infeções no trato respiratório e gastroenterites na infância, o consumo de tabaco e a apendicectomia têm sido considerados como fatores protetores para o desenvolvimento de CU. Neste contexto, dada a necessidade de melhoria da qualidade de vida dos doentes com CU ao prevenir a doença ou retardar o desenvolvimento clínico da mesma e partindo do conhecimento pré-existente sobre a apendicectomia enquanto procedimento cirúrgico, da literatura existente sobre a influência da mesma no desenvolvimento da patologia e do que já fora efetivamente demonstrado em estudos animais, é feita uma revisão da literatura que permita colocar a comunidade cirúrgica e gastroenterológica a par desta problemática, podendo assim melhor orientar os seus doentes. Três modelos animais pré-clínicos independentes apoiam a existência de um papel protetor no desenvolvimento da colite ulcerosa associado à apendicectomia realizada em ratinhos de idade jovem. A investigação em humanos gerou maior controvérsia, apresentando como limitações o facto de não se poder realizar cirurgias profiláticas sem evidência comprovada de que isso não iria causar mais dano do que benefício ao doente. Assim, tendo em conta a investigação até hoje realizada, conclui-se que a apendicectomia, ao contrário do que vários estudos indicam, não tem um valor protetor da evolução da CU.
Ulcerative Colitis (UC) is a chronic inflammatory bowel disease that is confined to the mucous layer of the colon, which relapses cyclically to colectomy - the disease’s terminal state. Although its etiology remains uncertain, it is believed that it depends on a multiplicity of genetic and environmental factors. On the other hand, personal history of respiratory tract infections and childhood gastroenteritis, tobacco consumption and appendectomy have been considered as protective factors for the development of UC. In this context, given the need to improve the quality of life of patients with CU by preventing the disease or delaying its clinical development and starting from the preexisting knowledge about appendectomy as a surgical procedure, from the existing literature about its influence on the development of the pathology and what has already been effectively demonstrated in animal studies, a review of the literature is made that allows the surgical and gastroenterological community to be in line with this problem, so that they can better guide their patients. Three independent preclinical animal models support the existence of a protective role in the development of appendectomy-associated ulcerative colitis in young mice. Human research has generated more controversy, presenting as limitations the fact that prophylactic surgeries cannot be performed without proven evidence that this would not cause more harm than good to the patient. Thus, in view of the research carried out so far, it is concluded that appendectomy, contrary to what several studies indicate, does not have a protective value of the evolution of CU.
Ulcerative Colitis (UC) is a chronic inflammatory bowel disease that is confined to the mucous layer of the colon, which relapses cyclically to colectomy - the disease’s terminal state. Although its etiology remains uncertain, it is believed that it depends on a multiplicity of genetic and environmental factors. On the other hand, personal history of respiratory tract infections and childhood gastroenteritis, tobacco consumption and appendectomy have been considered as protective factors for the development of UC. In this context, given the need to improve the quality of life of patients with CU by preventing the disease or delaying its clinical development and starting from the preexisting knowledge about appendectomy as a surgical procedure, from the existing literature about its influence on the development of the pathology and what has already been effectively demonstrated in animal studies, a review of the literature is made that allows the surgical and gastroenterological community to be in line with this problem, so that they can better guide their patients. Three independent preclinical animal models support the existence of a protective role in the development of appendectomy-associated ulcerative colitis in young mice. Human research has generated more controversy, presenting as limitations the fact that prophylactic surgeries cannot be performed without proven evidence that this would not cause more harm than good to the patient. Thus, in view of the research carried out so far, it is concluded that appendectomy, contrary to what several studies indicate, does not have a protective value of the evolution of CU.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Apendicectomia Colite ulcerosa Cólon Colectomia