Appendicitis

Once labelled as a vestigial organ, the appendix is more recently though to be:

• A “safe-house” for useful bacteria when illness flushes the useful bacteria from the rest of the intestines. Before modern days such illnesses were likely to be dysentery from various types of infectious sources.
• Endocrine cells appear in the appendix of the human foetus at around the 11th week of development. These endocrine cells of the foetal appendix have been shown to produce various biogenic amines and peptide hormones, compounds that assist with various biological control (homeostatic) mechanisms. Lymphoid tissue begins to accumulate in the appendix shortly after birth and reaches a peak between the second and third decades of life, decreasing rapidly thereafter and practically disappearing after the age of 60.

Appendicitis is thought to result from an obstruction of the appendiceal lumen, often by lymphoid hyperplasia (in adolescents mainly). Blockages may also be by a faecolith, indigestible foreign body, or even by parasitic worms; studies have shown that faecoliths are the most common form of blockages leading to appendicitis.

With unchecked mucosal secretions, any such obstructions can lead to distention, bacterial and/or parasite overgrowth, ischemia, and inflammation. If untreated, necrosis, gangrene, and perforation may occur. If the perforation is contained by the omentum, an appendiceal abscess may result.

Without surgery or antibiotics (e.g., in a remote location or historically), the mortality rate for appendicitis is > 50%. With early surgery, the mortality rate is < 1%, and convalescence is normally rapid and complete.

A faecolith may result from adsorption and compaction (by dehydration and applied pressure) of faecal matter around undigested vegetable fibres or other indigestible matter.

Appendicitis is more common in developed than in developing societies. In one study the geographic distribution of appendiceal faecoliths was investigated by systematic examination of the appendix in patients in Toronto, Canada and Johannesburg, South Africa. The incidences of faecoliths found on pathologic sectioning of the appendix in appendicitis patients in both societies were compared. In the Canadian population, the prevalence of faecoliths in patients whose appendices were examined incidentally was 32% versus 52% for those with appendicitis. In the African population, the prevalence of faecoliths in patients whose appendices were examined incidentally was 4% versus 23% for those with appendicitis.

This data supports the hypothesis that low-fibre diets consumed in developed countries may lead to faecolith formation, which then predisposes the patients to appendicitis.

The kinetic formation of faecoliths is related to slowed peristalsis of the lower GI tract, combined with dehydration. In essence, a faecolith is more likely to form, from the adsorption of faecal material onto any undigested materials, in an environment which is slowly moving. Dehydration then enhances the compaction of the faecal material once adsorbed. Both factors, slow peristalsis and dehydration, are enhanced by a low dietary fiber diet. Further it could be postulated that the effectiveness of the GI tract to process materials is impacted by the quality and quantity of dietary fiber, and that a low dietary fiber diet may lead to the presence of more materials that can be the nucleation sites for faecoliths.

This discussion would suggest that the modern Western low fiber diet can only be sustained, by amongst other things, modern medical intervention including appendectomy.