Dear Ahmed,

Whenever there is any chronic inflammation in the GI tract and its associated organs, gallbladder(chronic cholecystitis), chronic or acute pancreatitis, the Enteric Nervous System gets stimulated. In my opinion, it is this stimulation of the ENS due to the chronic inflammation leads to the dyspepsia that is observed.

Chronic appendicitis does not exist. Frequently, patients with pain due to irritable bowel syndrome are labelled as "chronic appendicits" cases, but most emphatically they are not. IBS and dyspepsia associate frequently, so your observation is justified.

Of course there is chronic  recurrent appendicitis! In a most basic situation, a Payers patch (tonsil) may be inflamed and resolve with residuals of inflammation that can recurr over and over again. This is a chronic tonsillitis of the appendix. Is this concept an over-reach?

Stimulation of the Coelic or Superior Mesenteric Nerve - The "dyspepsia", anorexia, nonspecific discomfort, etc.  is from the same mechanism that explains the prodomal symptoms not only of appendicitis but of all intestinal organ organs so involved  because of the stimulatoty response by the  superior mesenteric nerve from any intraabdominal organ that it supplies.

A person can of course suffer more than one attack of acute appendicitis over the years. I agree with you on that. This does not, however, constitute a case of chronic appendicitis.

Let me rephrase and say this again: chronic appendicitis (i.e. a chronic inflammation of the vermiform appendix causing chronic symptoms, that can be safely and effectively treated by appendectomy as shown by good quality randomized trials) does not exist.