Appendix Removal Helps Bowel Problems

Nov. 13, 2002 -- Researchers have found a new hidden benefit to having your appendix removed -- it can help delay or even minimize inflammatory diseases of the bowel.

A new study shows that appendix removal before age 20 can delay the onset of both ulcerative colitis and Crohn's disease -- and could even result in a milder disease.

Genetics and smoking play a role in triggering inflammatory bowel problems. But in recent years, two studies have caused researchers to increasingly become interested in the role of the appendix in development of these disorders.

The study, reported in the current issue of Gut, reports "a relationship" between having the appendix removed early in life and development of ulcerative colitis and Crohn's disease, according to lead researcher G. L. Radford-Smith with the Royal Brisbane Hospital in Australia.

Radford-Smith and colleagues compared more than 600 people with either Crohn's disease or ulcerative colitis with people without an inflammatory bowel disease. They were asked about many lifestyle factors -- including smoking -- and appendix removal.

As expected, smokers were twice as likely to have Crohn's disease but less likely to have ulcerative colitis. The relationship between smoking and inflammatory bowel disease is well known but not understood.

Appendix removal statistics were the most compelling: "Normal" people were more than three times as likely to have had their appendix removed as patients with ulcerative colitis -- and more than twice as likely as those with Crohn's disease.

Those who had their appendix removed beforeage 20 were likely to have a milder case of ulcerative colitis. They also developed Crohn's disease at an older age. And among people with inflammatory bowel disease, those who had had their appendix removed did not require as much surgery or immune suppressing drugs as those who had not had their appendix removed.

Those diagnosed at an older age -- and who had their appendix removed at that time -- also had an easier time with their disease. Their disease was milder, and they didn't need as much surgery or drugs to treat their condition.

The researchers say the link behind this "novel" association may lie in the immune system. In someone with inflammatory bowel disease, the immune system has gone awry and is attacking the lining of the colon.

The appendix is part of the immune system -- though its exact role is not understood -- and it may stimulate the immune system in the gut, Radford-Smith suggests.

When the appendix is removed early in life, the intestines may be immune deficient. But for those people who are genetically vulnerable to inflammatory bowel problems, that immune deficiency may have a protective effect against those problems, he says.

Source: Gut, December 2002 • News release, BMJ Specialist Journals