Connection between caecum and Parkinson's risk
Lower risk of Parkinson's after cecal removal
One study found that people who had their cecum removed decades ago have a lower risk of Parkinson's. German experts point out, however, that the investigation has no causality (cause-consequence relationship) has proven and thus there is no reason for appendicitis in Parkinson's prophylaxis.
If in doubt, an operation is decided
Appendicitis often causes nonspecific symptoms. Because the diagnosis is usually complex and ultrasound, physical examination and blood count only give rise to suspicion, doctors opt for evidence of inflammation in case of doubt rather for an operation. People who had their cecum removed decades ago have a lower risk of Parkinson's disease, according to a study by American researchers. Nevertheless, the OP should not be performed as Parkinson's prophylaxis.Although it has been shown in a study that people who have been removed from the cecum, have a lower risk of Parkinson's. Nevertheless, there is no reason for the appendectomy for Parkinson's prophylaxis. (Image: decade3d / fotolia.com)
Study can not prove causality
In a study published in the journal "Science Translational Medicine", it has been shown that people who had their bowel worm (cecum) removed decades ago have a lower risk of Parkinson's.
However, the survey can not prove causality (cause-and-effect relationship) as an association study. For appendicitis surgery for Parkinson's prophylaxis there is thus no reason.
But the study provides new approaches for the development of future biomarkers and therapeutic approaches.
Thus, it could well be a milestone in the fight against Parkinson's disease, a disease with increasing incidence, not least because of the demographic development.
This is indicated by the German Neurological Society (DGN) in a recent communication.
Illness sets in later
According to the DGN, the deposition of the protein alpha-synuclein in nerve cells is discussed as the cause of Parkinson's disease.
It form so-called Lewy bodies in the nerve cells, which consist mainly of deposits of this protein and lead to the death of brain cells.
In two large epidemiological studies ("Swedish National Patient Registry" and "The Parkinson's Progression Markers Initiative") it was shown that people who had their cecum removed decades ago have a lower risk of Parkinson's.
A total of nearly 1.7 million people were included in these surveys from 1964, with 551,647 the appendix removed. Of those who no longer had a vermiform appendix, 644 developed Parkinson's, which was equivalent to a rate of 1.6 patients per 100,000 patients.
In contrast, the incidence rate among those living with the appendix was significantly higher at 1.98 per 100,000 people.
In addition, the study showed that parkinsonian diagnosis was made 1.6 years later in those who had undergone surgical removal of the appendix, or appendectomy, 20 years earlier than in the non-operated.
The appendectomy was thus associated with a later onset of Parkinson's disease.
In the cecum, disease-causing alpha-synuclein is accumulated
The authors of the study found that the appendix vermiformis also causes disease-inducing alpha-synuclein to accumulate in healthy people as well as in Parkinson's patients. This finding has been shown in independent studies for the entire rectum.
The hypothesis of Heiko Braak, an influential German neuroanatomist, states that this pathological alpha synuclein migrates into the brain via the vagus nerve and causes the disease there.
The conclusion of the current study was therefore that the cecum could play a potential role in the development of Parkinson's disease.
In patients with Parkinson's disease, twice as many monomeric alpha-synuclein were found in the appendix as in the healthy study participants.
In addition, it was noticeable that Parkinson's patients had a fourfold increased level of a shortened form of alpha-synuclein in the appendix.
Precautionary cecal OP?
"To draw the conclusion that all humans appendectomically as a precautionary would be premature and health policy is not responsible," said Professor. Dr. h.c. Günther Deuschl, Kiel.
"The difference between groups in the study was 0.38 cases per 100,000 people (1.6 vs. 1.98 sufferers per 100,000). This means that you would need to operate on a precautionary basis for 250,000 to 300,000 people in order to possibly end up with the diagnosis of Parkinson's in the end, "explains the expert.
It is also uncertain whether this one person can really save on parkinsonian diagnosis because the study was just an association study that showed that the risk of developing Parkinson's was lower in people who had undergone appendicitis.
However, the study does not provide any scientific proof that the reverse conclusion is true that surgery can prevent or delay Parkinson's disease.
Prospective, randomized, controlled intervention studies would have to be carried out for this purpose, but this would be unrealistic in view of the number of cases required.
Perspectives for improved diagnostics and therapy
Nevertheless, Prof. Deuschl rates the present study as highly informative.
"It opens up prospects for improved diagnostics and therapy - and thus an exciting, broad field of research," says the expert.
"We may be able to use these findings to find new biomarkers, such as certain alpha synuclein aggregates in the appendix, that may be predictive of Parkinson's disease. The same has already been suggested for colonic biopsies, "explains Deuschl.
"It is also important to investigate whether such aggregates could represent future therapy targets. In this respect, this study could certainly be a milestone in the fight against Parkinson's. "(Ad)