Basson publishes article in JAMA Surgery

GRAND FORKS, N.D.—Marc D. Basson, M.D., Ph.D., M.B.A., F.A.C.S., senior associate dean for Medicine and Research at the UND School of Medicine & Health Sciences (SMHS), is the lead author on a new research article that appeared recently in JAMA Surgery, the surgical offshoot of the Journal of the American Medical Association.

In the online edition of JAMA Surgery,published October 4, 2017, Dr. Basson (right) and a team of colleagues, which includes the chair emeritus of the SMHS Department of Internal Medicine, William P. Newman, M.D., and Daniel Persinger, M.D., a former SMHS resident currently working with surgical residents at Altru Health System, published a study suggesting that colonoscopy predisposes patients to appendicitis up to one week after colonoscopy. The article is expected to appear in the print edition of JAMA Surgery later this year.

“Depending on how you ask the question, it turns out that the rate of appendicitis and appendectomy in the first week after a colonoscopy was at least fourfold higher compared to these patients’ next 51 weeks,” explained Dr. Basson, noting that the research accounted for differences in the coding of procedures and other possible discrepancies in the administrative data. “By some measures, the increase was twelvefold.”

Because drawing such a conclusion required access to a large amount of data in order to achieve statistical significance, Dr. Basson and his team turned to the Fargo Veterans Administration (VA) Healthcare System for access to national Veterans Administration data, which included nearly 400,000 veterans across the United States who had experienced a screening colonoscopy between January 2009 and June 2014, and whose incidence of subsequent procedures could be tracked.

Despite the paper’s significant findings, Dr. Basson urged his patients not to draw the wrong conclusions: “To be clear, this is not to say that colonoscopy isn’t a safe thing or that people should be afraid to have the procedure done. Colonoscopy is valuable and the appendicitis rate is still very, very low—so low that we wouldn’t even have been able to define this increased risk without this huge dataset,” he explained. “But it is good to know that this is real, because this wasn’t known before. This opens up a new area of investigation, and now we can begin to ask questions about why this is happening. In addition, we can now have a higher index of suspicion for appendicitis in patients who have right-lower abdominal pain after colonoscopy, which may lead to earlier diagnoses.”

Although the reasons why colonoscopy increases the risk of appendicitis remain unclear, the article offers some theories, including asking if bacteria within the colon are altered as the bowel is prepared prior to colonoscopy in ways that increase the likelihood of infection, or if the increased air pressure caused by colonoscopy may have effects on the colon’s mucosa that can predispose a person to appendicitis.

The article is available online at: https://jamanetwork.com/journals/jamasurgery/fullarticle/2656357.

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Brian James Schill
Assistant Director, Office of Alumni and Community Relations
University of North Dakota School of Medicine & Health Sciences
701.777.2733
brian.schill@UND.edu | med.und.edu