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If your appendix becomes inflamed or infected, does it need to be removed right away?
For over a century, doctors have assumed that the appendix is a useless organ. They have documented that most people who have theirs removed suffer few if any health consequences. And appendix removal has been the standard option for appendicitis during much of that time.
But some are challenging this assumption, a study published Monday in The New England Journal of Medicine suggests antibiotics could be just as useful as surgery for many people. If their findings hold up in future studies, many people may be spared the potential consequences of appendectomy, such as surgical infection.
Is the Appendix Useless?
The appendix is a wormlike tube found near the entrance of the colon on the lower right side of the abdomen. It is part of the immune system. The purpose of the appendix has been debated for a long time. Many experts have concluded it has no important function today in people, and some have described it as a vestigial organ left over from our evolutionary past.
Indeed, when operating, surgeons usually remove the appendix even if it appears healthy in order to avoid future health problems, writes MedicineNet medical author Jay W. Marks, MD.
However, researchers have also found that an intact appendix can protect you from certain diseases, such as Crohn's disease, according to Dr. Marks. Your appendix seems to help repopulate your gut with healthy bacteria after a stomach infection, such as following a bout of diarrhea.
Now some scientists even believe the appendix plays an important role in keeping your gut microbiome healthy.
Who Gets Appendicitis?
Appendicitis is a blockage of your appendix that includes a combination of swelling, inflammation, and/or bacterial infection. The NIH estimates that 5% of people in the US will develop appendicitis eventually.
This condition is more common in men, and more common in people in their teens and twenties. But anyone can develop appendicitis at any age.
What Does the New Study Suggest?
The latest study followed more than 1,500 adults with appendicitis across 25 U.S. health centers. The group was divided in half. Half of the group members were treated with a 10-day course of antibiotics (often at home), while the other half was treated with surgery.
After 30 days, the group who had taken antibiotics fared no worse than the group treated with surgery. By 90 days, only 29% of the antibiotics group needed surgery.
This isn't the first study to show antibiotics are effective against appendicitis. But some recent studies have suggested surgery remains the most effective treatment.
The researchers explained that they wanted more data on the issue to help patients make an informed decision for themselves.
"We wanted to look from a patient perspective… which is the treatment that really is best for me?" trial investigator Giana Davidson, MD, MPH, FACS, said. "We knew that you could treat appendicitis with antibiotics, but we didn't know if you should."