September 1, 2014
Appendicitis has been a troubling illness for humans for centuries. It is an inflamed and infected appendix that can progress to a serious and life threatening infection and death without appropriate management.
Medically, until recently it was believed that an appendix had no function in the human gut. A biologist and researcher at NC State named Rob Dunn has proposed an alternate theory. The appendix is the store house for our good and friendly gut flora.
If you have a serious diarrheal illness or get exposed to antibiotics, it is now believed that the appendix reseeds the gut flora with your good bacteria. There is now data showing that humans that have their appendix removed have a three fold increase in serious GI infections like Clostridium difficile. Everything in our body is there for a reason even if we do not understand it.
Historically, the treatment for acute appendicitis is surgical removal. The cure rate is high. The downside is high cost and a surgical intervention that can have complications.
In a new prospective study dated April 2014 from the Journal of the American College of Surgery we have evidence for a novel non surgical approach. Dr. Minneci looked at uncomplicated appendicitis cases and offered the parents of the patients two choices: 1) standard appendectomy or 2) intravenous antibiotics for 24 hours followed by 10 days of oral antibiotics. Caveats to offering the choice were that the patients had pain for less than 48 hours, no radiographic evidence of rupture or abscess, and had a white blood cell count less than 18,000.
90 % of the patients had a successful non operative course. 3 patients had to go on to appendectomy without any further complication.
The cost of this therapy should be dramatically better than the surgical route. The patients returned to school 2 days earlier and parents rated the quality of the child's life higher. The appendix stays in to do its natural job and life is good.
I would absolutely recommend probiotics during and after the antibiotic therapy. Resetting the guts balance is paramount to avoiding gut dysfunction and subsequent disease.
This study is an example of medicine and medical research looking out for the patient and the bottom dollar. This is cheaper and better for everyone except the hospital who loses the OR charge. Amen to the research.
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