Johanna Gudjonsdottiraffiliated with the university
I. The incidence of acute appendicitis peaks in childhood, and appendectomy if the most common acute abdominal surgery worldwide. However, the pathogenesis of appendicitis is still not completely understood, i.e. what initially starts the inflammatory responses. In recent years, it has become evident that not all cases of appendicitis lead to perforation if left untreated. Rather, many patients have a spontaneously resolving inflammation. In the light of this, a new hypothesis of appendicitis being two different diseases, with two different types of underlying immune responses, was formed. Hence, today appendicitis is often classified as uncomplicated (phlegmonous) or complicated (gangrenous, perforated or appendicitis abscess). Both epidemiological and clinical studies have stated that complicated appendicitis is driven by a T-helper cell (Th)1 /Th17-dependent response and uncomplicated appendicitis has a Th2-dependent immune response. Which mechanisms are part of the pathogenesis of appendicitis? And how do they really differ between complicated and uncomplicated disease?
II. Diagnosis appendicitis in the pediatric population is still hampered with difficulties. This results in high rates of misdiagnosis, which in turn has two major negative consequences; negative appendectomies and delayed diagnosis, which increases both patient morbidity and health care costs. Unfortunately, neither the clinical prediction scores nor the laboratory tests available seem to help decreasing the rate of misdiagnosis. How can one as a clinician with higher accuracy decide which patients can go home, and which should be sent straight to surgery?
III. Today there are no diagnostic aid that accurately can distinguish uncomplicated from complicated appendicitis. The clinical management of pediatric patients with suspected appendicitis could probably benefit enormously from increased knowledge of the pathogenesis of the disease, including potentially different types of immune responses. In the best-case scenario, new biomarkers could differ between non-appendicitis abdominal pain and appendicitis, and also between uncomplicated and complicated disease. This would also facilitate research on different treatment options, i.e. appendectomy or antibiotics. Are there any novel biomarkers that could increase the diagnostic accuracy?
I. To increase knowledge of the pathogenesis of pediatric appendicitis, specifically by investigating the immune responses of complicated and uncomplicated appendicitis
II. To evaluate existing/develop new clinical predictors for appendicitis of different degrees of inflammation, specifically by validating existing clinical prediction scores for appendicitis
III. To evaluate novel biomarkers with the purpose to differ non-appendicitis abdominal pain from appendicitis, and uncomplicated from complicated disease