Air pollution may raise risk of appendicitis
CALGARY — Links have already been drawn between air quality and both lung and heart disease, and now University of Calgary researchers suggest high air pollution levels may increase the risk of appendicitis as well.
About one-in-12 Canadians will require an appendectomy during their lifetime. The appendix is a small, tube-like structure with no known function that is attached to the first part of the large intestine. When it becomes inflamed, there is no effective medical therapy and it must be removed.
“It’s a disease that affects tens of thousands of Canadians every year and the universal management for appendicitis is surgery. We did surgery in 2008 just like we needed to do surgery in 1908,” said Dr. Gil Kaplan, the principal investigator in a study of more than 5,000 adults who were hospitalized for appendicitis in Calgary between 1999 and 2006.
Kaplan said there was a dramatic increase in the occurrence of appendicitis in industrialized countries such as Canada, the U.S. and England following its recognition more than a century ago up until the mid and latter part of the 20th century when it started to decline along with the introduction of clean air legislation.
Using data from Environment Canada that collected hourly levels of ozone, nitrogen dioxide, sulphur dioxide, carbon monoxide and particulate matter of varying sizes, the U of C findings showed higher concentrations of air pollutants were associated with the occurrence of appendicitis in the population.
The apparent effect of air pollution was strongest during the summer months when people were more likely to be outside.
“We might have better insight into this disease and that might lead to better diagnostic tests or more novel approaches of managing it,” said Kaplan, who presented his findings Monday to the annual scientific meeting of the American College of Gastroenterology in Orlando, Florida.
“Air pollution is a modifiable factor, meaning that if we can reduce air pollution in society we may be able to prevent some cases of appendicitis and as a physician and an epidemiologist we strive for prevention,” he added.
Dr. Lawrence Schiller, program director of the Gastroenterology Fellowship Program at Baylor Hospital in Dallas, Texas found the research and its premise interesting.
“It’s not something that I think anyone would have predicted but they looked at it and there was an association and I think it’s very provocative,” said Schiller.
“We don’t normally think of environmental influences on something like appendicitis. The idea that something in the environment might trigger something like that is very novel.”
Schiller said he would like to know how the pollution affects the appendix and see the findings reconfirmed in a number of other cities outside of Calgary.
Kaplan said his group is in the process of trying to replicate this study in other Canadian cities in order to validate the findings and the next phase could happen as soon as next year.
There is a body of research already, said Kaplan, that could explain the link between air pollution and increased inflammation of the appendix.
“We know from large bodies of work that air pollution can have effects on lung diseases like asthma, heart disease, and scientists have thought that it is caused by an inflammation of the blood,” he said.
“Some of the inflammatory mechanisms we see in those other disease states we can actually see in patients with appendicitis so we think maybe there is that link,” Kaplan said.
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