Appendectomy andClostridium difficilecolitis: Relationships revealed by clinical observations and immunology

Abstract

Advances in understanding the interaction between the human immune system and the microbiome have led to an improved understanding of the function of the vermiform appendix as a safe-house for beneficial bacteria in the colon. These advances have been made despite long standing clinical observations that the appendectomy is a safe and effective procedure. However, more recent clinical data show that an appendectomy puts patients at increased risk for recurrent Clostridium difficile (C. difficile)-associated colitis, and probably other diseases associated with an altered microbiome. At the same time, appendectomy does not apparently put patients at risk for an initial onset of C. difficile-associated colitis. These clinical observations point toward the idea that the vermiform appendix might not effectively protect the microbiome in the face of broad spectrum antibiotics, the use of which precedes the initial onset of C. difficile-associated colitis. Further, these observations point to the idea that historically important threats to the microbiome such as infectious gastrointestinal pathogens have been supplanted by other threats, particularly the use of broad spectrum antibiotics.

Improvement of Alcohol-Poisoning Symptoms in Mice by the Oral Administration of Live Lactobacillus plantarum SN13T Cells

“…On the other hand, the dysbiosis of the intestinal microbiota in the cecum and large intestine was not observed, suggesting that the intestinal microbiota has been buffered in the passage of the cecum, because a branched cecum appendix is an apparent safe niche for intestinal bacteria. Thus, the appendix maintains the microbial biofilm composed of indigenous bacteria [32,33]. Considering these results, the microbiota recovery effect observed in the cecum is likely to be important to protect the large intestine from some undesirable bacteria.…”

The Link between the Appendix and Ulcerative Colitis: Clinical Relevance and Potential Immunological Mechanisms

“…However, awareness is increasing regarding the importance of this seemingly insignificant organ in the development and preservation of gut-associated lymphoid tissue (GALT) and the interaction with intestinal fl ora ( 1,2 ). With the growing number of reports linking the appendix to both the prevention and development of various pathologies (e.g., Clostridium diffi cile and ulcerative colitis (UC)), a better understanding of its function and the role of the commensal gut fl ora on immunology might be helpful in daily clinical practice (3)(4)(5).…”

Peer Review #1 of "Increased chronic kidney disease development and progression in diabetic patients after appendectomy: a population-based cohort study (v0.1)"

“…19 Furthermore, many studies have suggested that appendectomy may increase the risk of ulcerative colitis, colon cancer, C. difficile colitis, and rheumatic arthritis. [6][7][8][9] In this large, retrospective, population-based cohort study, we revealed that the risks of CKD (aHR 1.13, 95% CI 1.01-1.26, P = 0.037) and ESRD (aHR 1.59, 95% CI 1.06-2.37, P = 0.024) were higher among appendectomy patients than in the control cohort. These results support our supposition that there are associations between appendectomy and CKD and ESRD.…”

“…5 The appendix also contains the highest concentration of gut-associated lymphoid tissue, which has numerous functions. 6 Appendectomy is expected to profoundly alter the immune system and modulate the pathogenic inflammatory immune responses of the gut. 6 Furthermore, studies have shown that appendectomy-related impairment of the microbiota may lead to dysbiosis and induce various diseases, including ulcerative colitis, Crohn's disease, Clostridium difficile infection, colorectal cancer, rheumatoid arthritis, and cardiovascular disease.…”

“…6 Appendectomy is expected to profoundly alter the immune system and modulate the pathogenic inflammatory immune responses of the gut. 6 Furthermore, studies have shown that appendectomy-related impairment of the microbiota may lead to dysbiosis and induce various diseases, including ulcerative colitis, Crohn's disease, Clostridium difficile infection, colorectal cancer, rheumatoid arthritis, and cardiovascular disease. [6][7][8][9] To date, there is no evidence confirming that appendectomy contributes to CKD.…”