Ulcerative Colitis (UC) is a chronic inflammatory condition of the large bowel affecting more than 50,000 people in the UK, of whom around 40% will experience a relapse annually, with up to 25% requiring total colectomy in their lifetime. Reducing relapse and progression is a priority for patients. UC patients can be treated effectively with medical therapy, either with maintenance therapy (preventing disease relapse with 5-ASA tablet medication) or breakthrough therapy (treating active disease relapses). However, even on maintenance therapy the annual disease relapse rate is around 40% which will require escalation to high dose steroid medication with its incumbent risks and toxicity.
Research has shown that the appendix affects the development and activity of UC possibly due to the appendix being a rich source of bacterial load and innate white blood cells which are important constituents of mucosal inflammation. Several small studies in patients with active UC have found that appendicectomy reduces relapse, hospitalisation and medication usage, with the potential to prevent the need for future major surgery.
The aim of the ACCURE-UK study is to assess the feasibility and inform the design of a large, phase III, multi-centre randomised trial comparing standard medical therapy versus appendicectomy plus medical therapy