title: Appendectomy and Clostridium difficile colitis: 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.
authors.affiliation: Nathan L Sanders, R Randal Bollinger, Ryan Lee, Steven Thomas, William Parker, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States.
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Sanders
authors.forename: R Randal
authors.initials: RR
authors.lastname: Bollinger
authors.forename: Ryan
authors.initials: R
authors.lastname: Lee
authors.forename: Steven
authors.initials: S
authors.lastname: Thomas
authors.forename: William
authors.initials: W
authors.lastname: Parker
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001062:Appendectomy / Q000009:adverse effects*; D001065:Appendix / Q000276:immunology* / Q000382:microbiology; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology*; D006801:Humans; D064307:Microbiota
chemical_list: D000900:Anti-Bacterial Agents
keywords: Appendectomy; Clostridium difficile; Colitis; Diarrheal illness; Vermiform appendix
references.citation: Bull World Health Organ. 1999;77(8):651-66
references.pmid: 10516787
references.citation: Br J Surg. 1981 May;68(5):345-7
references.pmid: 7225763
references.citation: Clin Gastroenterol Hepatol. 2011 Dec;9(12):1072-7
references.pmid: 21699818
references.citation: Br J Surg. 1995 Feb;82(2):166-9
references.pmid: 7749676
references.citation: Am J Epidemiol. 1990 Nov;132(5):910-25
references.pmid: 2239906
references.citation: Lancet. 1969 Dec 6;2(7632):1229-31
references.pmid: 4187817
references.citation: CMAJ. 2004 Jul 6;171(1):51-8
references.pmid: 15238498
references.citation: Br Med J (Clin Res Ed). 1988 Apr 2;296(6627):953-5
references.pmid: 3129106
references.citation: Curr Med Res Opin. 2012 Jul;28(7):1193-202
references.pmid: 22612580
references.citation: Br Med J (Clin Res Ed). 1988 Apr 2;296(6627):956-8
references.pmid: 3129107
references.citation: Scand J Immunol. 2006 Aug;64(2):125-36
references.pmid: 16867157
references.citation: Am J Epidemiol. 1991 Sep 15;134(6):614-27
references.pmid: 1951266
references.citation: N Engl J Med. 1994 Jan 27;330(4):257-62
references.pmid: 8043060
references.citation: Mil Med. 1990 Aug;155(8):345-7
references.pmid: 2119012
references.citation: J Evol Biol. 2009 Oct;22(10):1984-99
references.pmid: 19678866
references.citation: Gastroenterol Clin North Am. 2001 Sep;30(3):753-77, ix-x
references.pmid: 11586556
references.citation: BMJ. 1993 May 1;306(6886):1168
references.pmid: 8369045
references.citation: J Clin Gastroenterol. 2010 May-Jun;44(5):354-60
references.pmid: 20048681
references.citation: Isr J Med Sci. 1979 Apr;15(4):314-7
references.pmid: 447497
references.citation: Science. 2008 Jun 20;320(5883):1647-51
references.pmid: 18497261
references.citation: World J Surg. 2006 Jun;30(6):1033-7
references.pmid: 16736333
references.citation: Int Arch Allergy Appl Immunol. 1979;59(4):465-8
references.pmid: 447419
references.citation: Trop Geogr Med. 1966 Jun;18(2):81-96
references.pmid: 5336491
references.citation: Nurs Stand. 2007 Jun 20-26;21(41):59
references.pmid: 17633344
references.citation: Br Med J. 1912 Dec 7;2(2710):1599-602
references.pmid: 20766420
references.citation: Postgrad Med J. 1973 Apr;49(570):243-9
references.pmid: 4760719
references.citation: J Theor Biol. 2007 Dec 21;249(4):826-31
references.pmid: 17936308
references.citation: Diabetologia. 2002 Apr;45(4):588-94
references.pmid: 12032638
references.citation: J Epidemiol Community Health. 1988 Jun;42(2):144-8
references.pmid: 3221163
references.citation: J Anat Physiol. 1900 Oct;35(Pt 1):83-100.9
references.pmid: 17232459
references.citation: BMJ. 1989 Nov 18;299(6710):1259-60
references.pmid: 2513902
references.citation: Science. 2005 Mar 25;307(5717):1915-20
references.pmid: 15790844
references.citation: mBio. 2013 Jan 15;4(1):
references.pmid: 23322636
references.citation: Am J Gastroenterol. 2009 Oct;104(10):2476-82
references.pmid: 19584834
references.citation: Immunology. 2003 Aug;109(4):580-7
references.pmid: 12871226
references.citation: J Clin Gastroenterol. 2010 Sep;44(8):529-30
references.pmid: 20601895
references.citation: Nat Rev Gastroenterol Hepatol. 2011 Dec 20;9(2):88-96
references.pmid: 22183182
references.citation: Med Hypotheses. 2011 Oct;77(4):494-504
references.pmid: 21741180
references.citation: Evol Med Public Health. 2013 Jan;2013(1):89-103
references.pmid: 24481190
references.citation: J Infect Dis. 2008 Feb 1;197(3):435-8
references.pmid: 18199029
references.citation: Future Microbiol. 2010 Oct;5(10):1483-92
references.pmid: 21073309
references.citation: J Clin Med Res. 2012 Feb;4(1):17-9
references.pmid: 22383922
references.citation: Clin Gastroenterol Hepatol. 2011 Dec;9(12):1044-9
references.pmid: 21871249