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