The appendix is not an organ we need, but when it malfunctions - the body certainly notices. An inflamed appendix can cause abdominal pain, fever, irregular bowel function and vomiting. Then again, an inflamed appendix might go unnoticed, until it ruptures. Upon rupture, the pus which has irritated and expanded the appendix will slowly seep out, potentially spreading bacteria to the bloodstream or other organs. Not a pleasant situation, but, what can we do? There are few ways to avoid appendix inflammation and rupture - eating a high-fiber diet is the best (and just about the only) preventative measure. Oh, and there's one more way we might be able to avert appendicitis: by reducing air pollution.
A study published just this month by Canada's National Institute of Environmental Health Scientists found that appendicitis patients were more likely to enter the hospital on days with high levels of ambient ozone pollution. Taking this as indication that there might be a connection between these pollutants and appendiceal inflammation, researchers from the University of Calgary in Alberta observed more than 35,811 patients over nearly four year, looking into ambient ozone levels in the days leading up to the appendicitis hospitalizations.
Researchers found what they were looking for: a positive association between appendicitis and average daily ozone levels in the seven days before appendix problems arose. The data collected indicates that for every pollutant increase of 16 parts per billion, there is an 11 to 22 percent increase in cases of ruptured appendixes.
But, isn't ozone supposed to be a good thing? Ozone in the stratosphere does indeed perform the important function of keeping humans safe from UV light and solar radiation. However, there's another kind of ozone - ground level ozone. When volatile organic compounds (such as those found in everyday air pollution) mix with nitrogen oxides, the result is a gas known as ambient ozone, which makes up much of the smog and haze that we associate with air pollution.
We already know the ambient ozone can have an effect on our health; leading to asthma and other throat and lung problems. It may seem odd to hear that an air pollutant could harm a non-respiratory system, but upon further reflection this theory makes a great deal of sense. For years, scientists have been investigating how air pollution affects bacteria in our intestines; because appendicitis is so closely linked to the functioning of the intestines (the appendix sits above the large intestine, and is most often inflamed due to fecal matter blockage), it stands to reason that an abnormal amount of a pollutant such as ozone could be a factor in irritating the appendix.
Appendicitis is a major health issue, and one that disproportionately affects developed and industrializing countries - a fact that adds further fuel to the correlation between appendix problems and pollution. The risk of needing medical help for an inflamed appendix is 1 in 15, and if treatment is delayed, a rupture can occur. In the United States, around $3 billion is spent on appendicitis hospitalization and care every year, and yet despite these costs and the global prevalence of the disease, we know very little about what causes appendix inflammation. If this recent research from Canada into the connections between appendicitis and pollution can offer more information as to how to prevent the appendix from becoming diseased, health care around the world has much to gain.
Studies performed on animals have likewise demonstrated a correlation between air pollution and intestinal function. For example, mice that have been exposed to ambient ozone will show altered microflora in their small and large intestines. These studies on animals have also shown air pollution's ability to cause cell death and other intestinal disruption.
However, there are many questions about appendicitis and air pollution still remain. The recently-published University of Calgary study found definite connections between ambient ozone and patients who were hospitalized with ruptured appendixes; however, the correlation between general, non-emergency appendix removals and pollution was less defined. Why would ambient ozone lead to ruptured appendixes, but not seem to correlate with general appendix inflammation? The University of Calgary team says that the association between ambient ozone and burst appendixes may have been more strong because a burst appendix is nearly impossible to misclassify. General appendix issues, however, could have been misdiagnosed, leading to a seemingly low correlation between these more benign appendix hospitalizations and levels of ambient ozone.
Clearly, more research is necessary to understand the extent to which air pollution can trigger appendicitis, and to find out if reducing ambient ozone might be able to stop disease, prevent hospitalizations and ultimately save lives and money around the world.