Low-dose aspirin and mesalazine for patients with familial adenomatous polyposis

Abstract

Key issues in colorectal adenoma chemoprevention revolve around drug efficacy and safety. In the case of familial adenomatous polyposis, these issues must be considered in the context of patients. One group are young patients, aged 10–20 years, undergoing regular colonoscopy to assess the emergence of adenomas. A second group are these same patients, now a bit older, having undergone colectomy or proctocolectomy, but who are at risk of recurrent adenomas and ultimately of cancer of the rectum or ileal pouch, as well as the duodenum. They might require an operation more morbid, owing to scars and even desmoid tumours associated with such previous surgery, than the original colectomy. In precolectomy and postcolectomy patients, the ultimate goal of chemoprevention must be to prevent or slow the growth of adenomas, thereby attenuating risk of cancer. This approach would reduce the need for or delay such surgery, also potentially decreasing the frequency of surveillance endoscopy. Chemoprevention with low-dose aspirin, mesalazine, or both in patients with familial adenomatous polyposis without previous colectomy (J-FAPP Study IV): a multicentre, double-blind, randomised, two-by-two factorial design trialLow-dose aspirin safely suppressed the recurrence of colorectal polyps larger than 5·0 mm in patients with FAP. These results suggest an effect of low-dose aspirin for FAP and could be an alternative method for preventing colorectal cancer in FAP. Full-Text PDF