Symptoms, causes, and treatment
Appendicitis is not a common disease in the United States.
However, it does affect an estimated 3 million adults who live with it. The most common symptom is abdominal pain, which can range from mild to severe over a short period, caused by inflammation or infection of the digestive tract. There are several different types of appendicitis, such as diverticulitis, Crohn’s disease, duodenal ulcers, and acute appendicitis. In many cases, these diseases can be treated by surgery. Common surgical techniques include open sesame resection (when a bowel is surgically divided into individual sections), endoscopy, and laparoscopic biopsy (when a small sample is removed for examination and testing), as well as minimally invasive techniques such as endocoolization (a procedure in which the intestines are filled with a solution of polyethylene glycol). If these treatments are unsuccessful, interventional pain management is often used. It involves the use of drugs, devices, and procedures to control and stop the symptoms of appendicitis.
Causes
Appendicitis is the name in honor of James S. Aiken, MD, an
American gastroenterologist who was the first to coin “adenitis” in
1837.
There is no known cause. Some research has suggested that bacterial infections associated with other illnesses, obesity, certain medications and environmental factors can play a role. Certain foods have also been linked to gastrointestinal infections and inflammation, including milk, chocolate, coffee, red meat, onions, garlic, leeches, wheat, broccoli, tomatoes, soybeans, peanuts, and yeast infection-related inflamed appendix. Eating too much fatty and spicy food can irritate your stomach and possibly increase the risk of getting appendicitis (although this has to do with what you eat and how it’s prepared). Certain medicines have also been linked to developing appendicitis. These include antibiotics, no steroidal anti-inflammatory medication (NSAIDs) like ibuprofen, methotrexate (a drug) prescribed for rheumatoid arthritis), and colostomy bagging products (like those made by Dr. Jaffe and Coloplast), oral contraceptives, antifungal medicine, and corticosteroids.
However, none of these substances, nor even the presence of a family history of appendicitis, is proven to reliably predict the development of appendicitis. Therefore, there is no evidence to suggest that the absence of one factor predisposes you to develop appendicitis. On the contrary, there may be multiple contributing factors that combine to make up the picture of an “appendicitis” patient. For example, if you had an episode of appendicitis in childhood, then the odds are that you will develop the condition again later on, but, likely, your ability to fight infection and inflammation may not improve over time, resulting in recurrent episodes of appendicitis. Alternatively, if you have other illnesses, like inflammatory bowel disease, then the likelihood that a genetic mutation may lead to appendicitis may increase. This is called familial hyperaldosteronism syndrome. There is no cure for appendicitis (although there are measures and medications to manage symptoms). Treatment is aimed at making the symptoms as manageable as possible and minimizing complications. An effective approach includes using a variety of options to target the pathophysiology of appendicitis, including physical therapy, dietary changes, and surgical intervention with early diagnosis.
Diagnosis
According to the Mayo Clinic, “diagnosis of appendicitis relies heavily on patient history. Your healthcare provider will ask about your symptoms and any history of appendicitis in your family. They should also ask whether you’ve experienced changes in your bowels. [You may] want to consider colonoscopy as a test if you’re afraid that another person at home may have a problem with their abdomen.” Because many patients also have other conditions, such as diabetes, it is important to consult both your doctor and your primary care physician before starting an antibiotic regimen. You may receive an initial diagnosis of appendicitis when you suspect appendicitis — for example, if you experience unexplained abdominal pain. After further investigation, a medical team may order imaging tests to identify the size of the appendix, which would indicate whether you might have appendicitis.
Ultrasound imaging and blood tests can help confirm that you have appendicitis.
Treatment
Depending on the type of appendicitis, surgery may be needed to remove the diseased tissue and replace it with healthy anatomy (more on that later). However, in general, surgical treatment depends on what type of appendicitis you have, your level of pain, or the extent of the damage. Surgery may involve removing infected tissue and repairing the remaining intestine or covering up a hole in the intestine so that it won’t tear again. Other approaches include taking antacids to reduce pain or avoid nausea caused by diarrhea. Antibiotics are typically administered intravenously during the operation. When all of these methods fail, interventional pain management may be necessary.
Intervention
The goal of interventional pain management is to relieve pain and reduce discomfort, as quickly as possible. Interventional procedures vary widely based on the location and complexity of your appendicitis, so you’ll need to see a qualified surgeon before deciding which treatment is best.