Appendix

Is Your Appendix a Gut-Health Hero?

Posted by

0


Appendectomies are linked to Crohn’s Disease and shorter lifespan, while research shows alternative approaches can alleviate pain better than surgery. 

Is Your Appendix a Gut-Health Hero? 
Study by study, evidence shows there’s purposes for the appendix wrapped up in our immune and gut microbiome health.

The case for keeping your appendix—when possible—continues to grow, with new evidence emerging that removing it could cause an inflamed bowel down the road.

A systematic review and meta-analysis showed those who’ve undergone surgery to remove their appendix may have 53 percent elevated odds of developing Crohn’s disease, an inflammatory bowel disease (IBD). This finding, presented in December 2023 at the Advances in Inflammatory Bowel Diseases annual meeting, substantiates accumulating evidence that the appendix plays an important immunomodulating role.

Made up of lymphatic tissues, the appendix is now believed to help maintain balance in the gut microbiota, which consists of the bacteria, viruses, fungi, and other microorganisms that live in the gastrointestinal (GI) tract. The gut microbiome helps coordinate digestive and other bodily functions while playing an immunoprotective role by fighting off pathogenic microbes.

Should It Stay or Should It Go?

It’s been widely accepted that it won’t hurt you to have your appendix removed, but there can be great harm if you leave it in when it needs to go. A ruptured appendix allows infection-causing bacteria to spill out into the abdomen and potentially cause a deadly sepsis infection.

Because appendicitis—inflammation of the appendix—can sometimes lead to rupture, removal is often a rubber-stamped decision. Appendectomy can be performed laparoscopically, making it a low-risk and quick procedure.

While there are several different methods of removing the appendix, appendectomy remains one of the most commonly performed surgeries. In fact, about 8 percent of the population can expect to face acute appendicitis requiring emergency surgery.

William Parker, a retired Duke University professor who holds a doctorate in chemistry from the University of Nebraska, and other immune function researchers believe it’s time to re-examine the long-held belief that the human appendix is a vestige of evolutionary development—an organ without use or purpose in a modern age

But that doesn’t mean patients shouldn’t take appendicitis seriously.

“We never want to encourage anyone to not go to the hospital,” Mr. Parker told The Epoch Times. “If your appendix gets inflamed and starts leaking bacteria, it can kill you. It’s really hard to treat death.”

A Bacterial Safehouse

Mr. Parker led a group of researchers who first proposed in 2007 that the finger-shaped organ attached to the large intestine helps modulate immunity by serving as a protective shelter for good bacteria. They suggested the organ provides commensal microbes [bacteria that live in harmony with their host] a place to hide during an attack—such as an infection or food-borne illness—so they can repopulate and rebalance the gut microbiota once the threat clears.

The physical location of the appendix in the lower right quadrant of the large intestine makes it a logical place for such a storehouse, tucked out of reach from the stream of fecal bacteria.

Additional evidence, such as a better understanding of commensal microbes and their relationship with the immune system, makes the theory plausible, according to the article published in the Journal of Theoretical Biology.

The concern is whether appendectomy is throwing off the balance of microbes—a condition referred to as dysbiosis—in a way that would make the immune system overreact. That could potentially lead to tissue damage, including a breakdown of the thin layer of mucus that protects the rest of the body from assaults in the GI tract.

“What you have to keep in mind is [the appendix] contains a lot of immune tissue. So when you take out the appendix, you can immunosuppress the patient. You can get increases in certain infections and cancer,” Mr. Parker said.

It’s plausible that the lack of an appendix could be associated with Crohn’s disease—among other health problems—based on his previous research and understanding of the appendix, he added. Effects likely hinge on the microbiome being destabilized.

Could Appendectomies Also Be Protective?

However, the same study also found that having one’s appendix removed reduces—by 40 percent—the likelihood of someone developing ulcerative colitis, the other form of IBD. Similar findings have been previously reported, Mr. Parker said.

IBD—believed to be a chronic condition of the gastrointestinal system—continues to grow in tandem with industrialization. Crohn’s can affect any part of the GI tract, whereas ulcerative colitis affects the large intestine. Nearly 1 in 100 Americans have IBD, according to the Crohn’s & Colitis Foundation.

The new study, led by Dr. Suprada Vinyak of Ballad Health, examined trends in 23 studies from a pool of more than 100,000.

“Subsequently, our quantitative analysis included six studies that conformed to the highest standards,” Dr. Vinyak said in a news release.

Researchers expected both forms of IBD to be associated with having had an appendectomy, which made the results a bit surprising, she said in a MedPage Today article.

According to Dr. Vinyak, more research is needed to validate how appendectomies offer protection from ulcerative colitis, tease out any biases in data, and determine the underlying mechanisms.

Evolutionary Favor

The new finding isn’t the only interesting one about the value of the appendix that has recently surfaced in research.

An animal study published in September 2023 in Scientific Reports examined the veterinary records of 1,251 primates belonging to 45 species. Of those, 13 species had an appendix. A lower risk of severe diarrhea (by about 85 percent) was discovered among those species with an appendix, including a delayed onset of diarrhea. There were also no cases of acute appendicitis for 20 years among those primates with an appendix.

“The observation of a particularly high protective effect in the first part of life, the period most vulnerable to severe diarrhea, but also the most optimal in terms of reproductive capacity, argues in favor of a selective advantage role in evolution,” said Éric Ogier-Denis, Inserm research director at the Oncogenesis Stress Signaling unit at France’s University of Rennes, in a news release.

Another study by Inserm in 2021 documented that the appendix has developed at least 16 times during the evolutionary history of mammals, illustrating its positive selection advantage. Examining data on 258 mammals, the researchers concluded the appendix was also associated with longevity.

The researchers stopped short of saying that people should try to keep their appendix. Rather, Mr. Ogier-Denis reported in the news release that “the treatment for appendicitis remains appendectomy and this work does not provide any evidence to suggest this treatment approach should be changed. Only an appendectomy performed in a patient without appendicitis might have harmful consequences in the context of inflammatory and infectious bowel disease.”

Honoring the Necessity of Every Organ

Kat Owens, certified functional nutritional therapy practitioner, said it never made sense to her that any organ in the human body would be completely unnecessary.

“It’s not like we are just fundamentally broken machines. Our body can heal, and they were made that way for a reason,” she told The Epoch Times. “I think people can come to that conclusion whether their perspective is that God created you and he didn’t make a mistake when he made us—or whether your perspective is that your body developed this way, and why would we have something completely unnecessary.”

Ms. Owens said a humanist perspective has brought society to a place where we no longer question efforts to alter the body. New research on the appendix, she said, illustrates that we can learn more about what the organ does so that we might value preserving it.

Has Sanitation Hijacked the Role of the Appendix?

Mr. Parker’s 2007 paper refers to research from the 1980s which suggests that industrialization is behind the rise in appendicitis, potentially because we have severely eliminated a lot of the threats that would allow our appendix to spring to action.

That research from the 1980s, now widely accepted, indicates that our overly sanitized lifestyles don’t put us in a position where we need to tap into the appendix’s microbial reserve. In addition, that sanitation leads to an overactive immune system that can, in turn, lead to appendicitis, as well as high incidences of immune-related ailments such as allergy and autoimmune disease.”

This kind of use-it-or-lose-it argument makes sense to Ms. Owens.

“We live in these overly sanitized conditions, and that has probably kept us from experiencing the kind of things that would put our appendix to work,” she said. “It is so interesting to realize that not only does the appendix have an important job but it actually needs to be used, and we create problems for ourselves when it doesn’t need to be used.”

Another Treatment Option

Newer research is pointing to an alternative to appendectomy—a minimally invasive procedure called endoscopic retrograde appendicitis therapy (ERAT). The procedure involves a flexible endoscope that irrigates and drains the infection in an inflamed appendix. It can be performed under conscious or local anesthesia.

ERAT offers the most immediate pain relief out of all treatment options for appendicitis, which includes surgery and antibiotic therapy. It also reduces immediate health care costs.

That’s according to a meta-analysis published October 2023 in Surgery that looked at six studies comparing the treatment options. Appendectomies show superior outcomes for recurrence, but the study concluded that should be balanced against the benefits of a gentler approach for patients.

Antibiotic treatment is the acceptable first-line therapy in uncomplicated cases of acute appendicitis. In complicated cases, antibiotics may kill the bacteria, but they won’t solve the problem of obstructions. Antibiotics alone fail in about 10 percent of cases, and more than 27 percent of those who take them experience a recurrence of infection within a year.

Antibiotics also represent a vicious cycle of sorts, as they alter the microbiome, which is associated with a number of diseases, including Crohn’s disease. However, the study in Surgery said about half of patients are willing to accept a recurrence rate below 50 percent within a year to avoid surgery. The trend in patients who prefer to save their appendix should drive research on alternatives to appendectomy, the study said.

“Similarly, emerging evidence shows that an increasing number of parents prefer conservative management of uncomplicated appendicitis over surgical management for their children owing to fears of surgical risks and complications. Considering that the appendix plays an essential role in regulating immunity and the composition of the intestinal microbiome, all efforts should be made to preserve the organ in children during their period of development until solid evidence on the long-term consequences of appendectomy on the potentially increased risk of colorectal cancer and cardiovascular diseases has accumulated,” the study concluded.

Strategies for Life Without an Appendix

Furthermore, Mr. Parker said patients are often not told certain strategies can help their immune system function better if they have already had an appendectomy—that also needs to be part of the treatment conversation.

For anyone who’s had an appendectomy, he suggested supplementing with vitamin D, lowering stress levels, and taking a probiotic—especially when taking an antibiotic.

“Always take probiotics with antibiotics,” he emphasized. “In the United States, medical professionals often will not tell you to take a probiotic when you take an antibiotic. The main reason is it’s just not a standard of care. It has been demonstrated in the medical literature that it is super helpful.”

Are All Our Organs Vital?

Posted by

1


Even the appendix and tonsils are less expendable than we thought

Are All Our Organs Vital?  

Medicine has not always shown a lot of respect for the human body. Just think about the ghoulish disregard early surgeons had for our corporeal integrity. They poked holes in the skull and copiously drained blood with leeches or lancets—a practice that remained a medical mainstay through the late 19th century. Even today many of the most popular surgeries involve the wholesale removal of body parts—the appendix, gallbladder, tonsils, uterus (usually after the childbearing years)—with an assurance that patients will do just fine without them. There are many valid reasons for these “ectomies,” but what has become increasingly less defensible is the idea that losing these organs is of little or no consequence.

Take the appendix. Or rather leave it be, if possible. Many of us learned in school that this tiny, fingerlike projection off the colon is a useless, vestigial remnant of our evolution, much like the puny leg bones found in some snakes. But that idea has been debunked, says evolutionary biologist Heather Smith, director of Anatomical Laboratories at Midwestern University in Arizona. A 2017 study led by Smith reviewed data on 533 species of mammals and found that the appendix appears across multiple, unrelated species. “This suggests there’s some good reason to have it,” she says.

The reason appears to be immunological and gastrointestinal. In all species that have an appendix, Smith notes, it either contains or is closely associated with lymphoid tissue, which plays a role in supporting the immune system. In humans, the appendix also harbors a layer of helpful gut bacteria—a fact discovered by scientists at Duke University. In a 2007 paper, they proposed that it serves as a “safe house” to preserve these microbes, so that when the gut microbiome is hit hard by illness, we can replenish it with good guys holed up in the appendix. Some evidence for this idea surfaced in 2011, when a study showed that people without an appendix are two and half times more likely to suffer a recurrence of infection with Clostridium difficile, a dangerous strain of gut bacteria that thrives in the absence of friendlier types.

The appendix may have more far-flung roles in the body—including some that can go awry. A study published last October found that misfolded alpha-synuclein—an abnormal protein found in the brain of Parkinson’s disease patients—can accumulate in the appendix. Intriguingly, the study found that people who had the organ removed as young adults appear to have some modest protection against Parkinson’s.

New research has also shed light on the value of our tonsils and adenoids. In a study published last July, an international team assessed the long-term impact of removing these structures, or leaving them, in 1.2 million Danish children. Over a follow-up period of 10 to 30 years, the 5 percent or so who had one or both sets of organs extracted before age nine were found to have a twofold to threefold higher rate of upper respiratory diseases and higher rates of allergies and asthma. Notably they suffered more frequently from ear infections and, in the case of adenotonsillectomies, sinus infections—conditions thought to be helped by surgery.

We have known for a long time that the adenoids and tonsils “act as a first line of defense against pathogens that enter through the airways or eating,” says Sean Byars, a senior research fellow at the Melbourne School of Population and Global Health and lead author of the paper. The fact that these tissues are most prominent in children, with the adenoids nearly gone by adulthood, has bolstered the view that they are not essential, but as Byars points out, “maybe there’s a reason they are largest in childhood.” Perhaps they play a developmental role, helping to shape the immune system in ways that have lasting consequences.

Byars cautions that his study, large though it is, awaits confirmation by others and that the decision to treat any given child must be made on an individual basis. Still, he says, “Given these are some of the most common surgeries in childhood, our results suggest a conservative approach would be wise.”

It is worth noting that tonsillectomy rates have declined in the U.S., especially since the heyday in the mid-20th century. Surgeons are also doing fewer hysterectomies, reflecting a growing view that the uterus does not outlive its usefulness once childbearing is done and that there are less drastic ways to address common issues such as fibroid tumors.

So are any human body parts truly useless or vestigial? Perhaps the best case can be made for the wisdom teeth. “Our faces are so flat, compared with other primates, that there’s often not room for them,” Smith observes. And given how we butcher and cook our food, “we really don’t need them.”

Does Our Appendix Really Hold Any Purpose? Scientists Have Discovered It’s Really Important

Posted by

0


For a long time, the purpose of our appendix has been somewhat of a mystery.  However, scientists are now convinced that they know why we do indeed have this small, thin tube that’s attached to the large intestine. Up until now, the appendix has always been considered as a pointless organ that is prone to appendicitis – a painful inflammation that often results in surgery.

But, researchers at Midwestern University, Arizona believe that the appendix may serve as a reservoir for good bacteria found in the gut. As part of a recent study on the evolution of the appendix, the intestines and environmental characteristics of over 500 different mammals were analyzed. Results showed that while certain animals like primates and rabbits have an appendix, others such as cats and dogs don’t. The team also discovered that in some species, the appendix had evolved 30 separate times and very rarely did it ever completely disappear from a lineage once there.

A diagram of the large intestine with the appendix visible on the left hand side Rex Features

The scientists also discovered during the study that those animals that did have an appendix also had a higher concentration of lymphoid tissue in the gut, which plays a vital role within the immune system. Lymphoid tissue is particularly useful as it has the ability to stimulate the growth of certain bacteria that can be stored in the appendix. Associate Professor, Heather Smith, said that for some people who’ve had their appendix removed it could take, “slightly longer to recover from illness, especially those in which the beneficial gut bacteria has been flushed out of the body.”

Your appendix might serve an important biological function after all 

Posted by

0


One of the first things you learn about evolution in school is that the human body has a number of ‘vestigial’ parts – appendix, wisdom teeth, tailbone – that gradually fell out of use as we adapted to more advanced lifestyles than our primitive ancestors.

But while our wisdom teeth are definitely causing us more pain than good right now, the human appendix could be more than just a ticking time bomb sitting in your abdomen. A new study says it could actually serve an important biological function – and one that humans aren’t ready to give up.

Researchers from Midwestern University traced the appearance, disappearance, and reemergence of the appendix in several mammal lineages over the past 11 million years, to figure out how many times it was cut and bought back due to evolutionary pressures.

They found that the organ has evolved at least 29 times – possibly as many as 41 times – throughout mammalian evolution, and has only been lost a maximum of 12 times.

“This statistically strong evidence that the appearance of the appendix is significantly more probable than its loss suggests a selective value for this structure,” the team reports.

“Thus, we can confidently reject the hypothesis that the appendix is a vestigial structure with little adaptive value or function among mammals.”

If the appendix has been making multiple comebacks in humans and other mammals across millions of years, what exactly is it good for?

Conventional wisdom states that the human appendix is the shrunken remnant of an organ that once played an important role in a remote ancestor of humans millions of years ago.

The reason it still exists – and occasionally has to be removed due to potentially fatal inflammation and rupturing – is that it’s too ‘evolutionarily expensive’ to get rid of altogether. There’s little evolutionary pressure to lose such a significant part of the body.

In other words, the amount of effort it would take for the human species to gradually lose the appendix though thousands of years of evolution is just not worth it, because in the majority of people, it just sits there not hurting anyone.

appendix-removed_1024

But what if it’s doing more than just sitting there?

For years now, researchers have been searching for a possible function of the human appendix, and the leading hypothesis is that it’s a haven for ‘good’ intestinal bacteria that help us keep certain infections at bay.

One of the best pieces of evidence we’ve had for this suggestion is a 2012 study, which found that individuals without an appendix were four times more likely to have a recurrence of Clostridium difficile colitis – a bacterial infection that causes diarrhoea, fever, nausea, and abdominal pain.

As Scientific American explains, recurrence in individuals with their appendix intact occurred in 11 percent of cases reported at the Winthrop-University Hospital in New York, while recurrence in individuals without their appendix occurred in 48 percent of cases.

Now the Midwestern University team has taken a different approach to arrive at the same conclusion.

First they gathered data on the presence or absence of the appendix and other gastrointestinal and environmental traits across 533 mammal species over the past 11.244 million years.

Onto each genetic tree for these various lineages, they traced how the appendix evolved through years of evolution, and found that once the organ appeared, it was almost never lost.

“[T]he appendix has evolved independently in several mammal lineages, over 30 separate times, and almost never disappears from a lineage once it has appeared,” the team explains in a press statement.

“This suggests that the appendix likely serves an adaptive purpose.”

Next, the researchers considered various ecological factors – the species’ social behaviours, diet, habitat, and local climate – to figure out what that “adaptive purpose” could be.

They found that species that had retained or regained an appendix had higher average concentrations of lymphoid (immune) tissue in the cecum – a small pouch connected to the junction of the small and large intestines.

This suggests that the appendix could play an important role in a species’ immune system, particularly as lymphatic tissue is known to stimulate the growth of certain types of beneficial gut bacteria.

“While these links between the appendix and cecal factors have been suggested before, this is the first time they have been statistically validated,” the team concludes in their paper.

“The association between appendix presence and lymphoid tissue provides support for the immune hypothesis of appendix evolution.”

The study is far from conclusive, but offers a different perspective on the hypothesis that humans have been keeping the appendix around for its immune support this whole time.

The challenge now is to prove it, which is easier said than done, seeing as most people who have had their appendix removed don’t suffer from any adverse long-term effects.

But it could be that when people get their appendix removed, immune cell-producing tissues in the cecum and elsewhere in the body step up to compensate for the loss.

One thing’s for sure in all of this – while we’re probably not going to regain our tails, it’s too soon to write off the appendix just yet.

Women without tonsils or appendix may be more fertile.

Posted by

0


Have you had your tonsils or appendix removed? If you have and you’re a woman, you probably weren’t told that the surgery may have increased your chances of having a baby.

In fact, you may have been told the opposite.
But a new 15-year study found that women who had their tonsils or appendix removed when they were young are more likely to get pregnant — and to do so earlier in life.
The reasons behind the link are not fully understood.
Researchers at the University of Dundee examined the medical records of more than 530,000 women across the United Kingdom and found pregnancy rates to be higher among women who had had their tonsils or appendix removed. Pregnancies were even higher among people missing both.
Rates of pregnancy among women without an appendix or tonsils were 54% and 53%, respectively, and rates in women lacking both parts of their body were 59%. This was higher than pregnancies among the group representing the rest of the population, which was almost 44%.
The findings go against previous theories in medicine that these surgeries, particularly appendectomies, reduce chances of fertility due to scar tissue forming around a woman’s fallopian tubes, where her eggs travel.
“The study has challenged the myth that was previously accepted on the deleterious effects of appendectomies,” said Dr. Sami Shimi, a consultant surgeon and clinical lecturer in surgery at the University of Dundee who led the study. “Young women should not have any fear or anxiety about an appendectomy (or tonsillectomy) reducing their fertility.”
The current research follows a report in 2012 that linked appendectomies to higher rates of pregnancy. The new study backs this previous insight on a wider scale but added the extra association with tonsillectomies and people who have undergone both surgeries.

Biology or behavior?

It’s hoped the findings will reassure women who need these surgeries, but the researchers are now eager to understand why fertility was seen to increase.
“We now need to find the mechanism,” Shimi said. He believes there could be either a biological or behavioral reason behind it. “We’re not discounting either for now.”
The biological contender is the idea that inflammation within the body from a continually inflamed appendix, or tonsils, puts strain and burden on the body, weakening it and potentially reducing chances of conception.
Alternatively, Shimi suggests that increased promiscuity among some women, and therefore increased contact and intimacy — through kissing or sex — may directly increase chances of tonsillitis or else chances of abdominal infection. The latter would not cause appendicitis as such but could lead to more abdominal infections or pain, which is more likely to lead to hospital referrals and investigations in which an inflamed appendix may be spotted more readily.
Both options need further investigation.
“It’s a very interesting association they’ve shown here,” said Richard Anderson, professor of clinical reproductive science at the University of Edinburgh, who wasn’t involved in the new study. “The issue is that it’s purely an association.”
Anderson warns that people may believe that the two factors — the surgeries and fertility — are causally linked, but “there’s no evidence of that here.” He added that the real question now is whether women who undergo these surgeries are more fertile or whether they are more likely to get pregnant at a younger age.
“Tonsillectomies are rare these days,” he added. “It’s whether women who chose to have their tonsils removed (rather than ongoing rounds of antibiotics) are also choosing to fall pregnant more often.”
Both Anderson and Shimi agree that the findings should instead be used to reassure women who need the surgeries and that those wanting to improve their fertility should not request to have them.
“Young women should not seek appendectomies or tonsillectomies to increase their chances of pregnancy,” Shimi said. “But if they need one, the operation will not reduce their future chances of pregnancy.”

Is Your Appendix Actually Useless?

Posted by

0


It’s commonly believed that the appendix no longer has a use. Is there any truth to this?

Its full name is Vermiform Appendix: “Vermiform” being Latin for “worm-shaped”, which describes the shape of this it. The human appendix is a 5-to-10 cm (2-to-4 inch) worm-like long protrusion jutting off the large intestine right by where the large and small intestine meet. Considered a “vestigial organ” — something that has lost its function through evolution — there is no general consensus among scientists about what the appendix’s actual purpose is.

However, recent a recent study from Duke University may have finally figured out the great mystery of the appendix’s function: a storehouse for “good bacteria” needed for digestion in the intestine. A side effect of diseases that cause chronic diarrhea — like cholera and dysentery — is that they can wipe out all the bacteria we need for digestion. It’s in situations like this, the study speculates, that our appendix would replenish this missing “good bacteria”.

This would also explain why we are capable of living without them. Appendicitis, or inflammation of the appendix, almost always results in the removal of the appendix and is one of the most common causes of acute abdominal pain. The classic signs of appendicitis are: pain in the stomach area first, followed by vomiting, and finally a fever. As appendicitis continues, the pain tends to focus in the lower-right quadrant of the abdomen.

So if we don’t need them, why is appendicitis so common? Scientists attribute this to what the refer to as the “hygiene hypothesis”. Basically, it purports that because our ultra-hygienic society rarely exposes us to dangerous pathogens, when we actually are, our bodies tend to overreact. There are fewer complications if you have your appendix removed before it ruptures, so of you have some intense pain in your abdomen you should see a doctor immediately. Have you had your appendix removed? If so, be sure to share your experiences in the comments section below.