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World J Gastroenterol. Sep 14, 2013; 19(34): 5607-5614
Published online Sep 14, 2013. doi: 10.3748/wjg.v19.i34.5607
Appendectomy and Clostridium difficile colitis: Relationships revealed by clinical observations and immunology
Nathan L Sanders, R Randal Bollinger, Ryan Lee, Steven Thomas, William Parker
Nathan L Sanders, R Randal Bollinger, Ryan Lee, Steven Thomas, William Parker, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
Author contributions: All authors contributed to the analysis of pertinent literature and to the writing of the manuscript.
Correspondence to: William Parker, PhD, Department of Surgery, Duke University Medical Center, 200 Trent Dr, Durham, NC 27710, United States. bparker@duke.edu
Telephone: +1-919-6813886 Fax: +1-919-6847263
Received: June 12, 2013
Revised: July 13, 2013
Accepted: August 5, 2013
Published online: September 14, 2013
Core Tip

Core tip: Although the function of the appendix has remained an enigma for centuries, recently emerging advances in the fields of immunology and gut microbiology have merged with observations made in the clinic to form a coherent picture. Although the appendix is apparently a safe-house for beneficial bacteria, it seems likely that this safe-house does not satisfactorily protect the microbiome from broad spectrum antibiotics. In this view, selection pressures which threatened the microbiome and likely drove the evolution of the appendix have been supplanted in post-industrial society by new threats to the microbiome that the human body is not adapted for.