Is Your Appendix a Gut-Health Hero?

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

Study by study, evidence shows there's purposes for the appendix wrapped up in our immune and gut microbiome health. Shutterstock

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.”