Colonic Adenomatous Polyps Research Articles

Increase in Body Size Is Associated with an Increased Incidence of Advanced Adenomatous Colon Polyps in Male Veteran Patients

Background/Aims: Our aim was to determine how weight change influences the development of advanced adenomas. Methods: We performed a retrospective study of patients with adenomatous polyps (APs) on an index colonoscopy, and who also had a follow-up colonoscopy 3–5 years later. APs were evaluated for advanced features (i.e. size ≧1 cm in diameter and/or villous component and/or high-grade dysplasia). Patients were divided into 2 groups: those with no change or a reduction in their body mass index (BMI) during the interval between colonoscopies and those with an increase in BMI during the interval between colonoscopies. Results: 925 patients with a history of APs were identified. Univariate analysis showed that patients with an increase in BMI had more advanced APs (28 vs. 23%, p = 0.04), and a larger mean AP size (8.0 vs. 6.8 mm, p = 0.03) than those with a no change or decreased BMI. Multiple logistic regression analysis revealed that a decrease in BMI between colonoscopies was associated with a significantly reduced risk of developing advanced APs (OR: 0.4, 95% CI: 0.37–0.5, p < 0.05). Conclusions: An increase in weight in male veterans appears to be strongly associated with the development of clinically advanced AP lesions, even after adjustment for other known polyp risk factors.

Goblet cell carcinoids at extraappendiceal locations of gastrointestinal tract: An underrecognized diagnostic pitfall

Goblet cell carcinoid (GCC) is a clinicopathologically distinctive tumor that typically arises in appendix and metastasizes frequently. Although rare cases of ostensibly primary extraappendiceal GCC (EGCC) have been reported, the distinction from extraappendiceal metastasis of occult appendiceal primary may be problematic and has not been dealt with systematically in literature. We reviewed our combined experience with EGCC at four North American hospitals and reevaluated all EGCC cases published in literature. We encountered 16 cases that were initially reported as EGCC. Five cases presented with disseminated abdominopelvic spread, nine cases with mass lesions in stomach, ileum, cecum, ascending colon, hepatic flexure, sigmoid, and rectum. One case was found incidentally in an ascending colon adenomatous polyp. A negative appendix was confirmed in 2 (12.5%) cases, whereas a primary appendiceal GCC was discovered in 4 (25%) cases at a later date, and appendix was not available for review in 10 cases (62.5%). Of 10 cases of EGCC found in literature, the tumor sites included stomach, duodenum, jejunum, ileum, cecum, splenic flexure, and rectum. Primary appendiceal tumor was excluded histologically in one (10%), grossly in three (30%), and not at all in six (60%). Nine of our cases were initially misdiagnosed as signet-ring cell adenocarcinomas. True EGCC is extremely rare. GCC found at locations other than appendix are most likely extraappendiceal presentations of appendiceal primary. A thorough review of the pathologic status of appendix should be a mandatory diagnostic criterion and should always be documented in the pathology reports.

The Inflammatory Microenvironment in Colorectal Neoplasia

Colorectal cancer (CRC) is a major cause of mortality and morbidity worldwide. Inflammatory activity within the stroma of invasive colorectal tumours is known to be a key predictor of disease activity with type, density and location of immune cells impacting on patient prognosis. To date, there has been no report of inflammatory phenotype within pre-malignant human colonic adenomas. Assessing the stromal microenvironment and particularly, inflammatory activity within colorectal neoplastic lesions is central to understanding early colorectal carcinogenesis. Inflammatory cell infiltrate was assessed by immunohistochemistry in paired colonic adenoma and adjacent normal colonic mucosa samples, and adenomas exhibiting increasing degrees of epithelial cell dysplasia. Macrophage phenotype was assessed using double stain immunohistochemistry incorporating expression of an intracellular enzyme of function. A targeted array of inflammatory cytokine and receptor genes, validated by RT-PCR, was used to assess inflammatory gene expression. Inflammatory cell infiltrates are a key feature of sporadic adenomatous colonic polyps with increased macrophage, neutrophil and T cell (specifically helper and activated subsets) infiltration in adenomatous colonic polyps, that increases in association with characteristics of high malignant potential, namely, increasing degree of cell dysplasia and adenoma size. Macrophages within adenomas express iNOS, suggestive of a pro-inflammatory phenotype. Several inflammatory cytokine genes (CXCL1, CXCL2, CXCL3, CCL20, IL8, CCL23, CCL19, CCL21, CCL5) are dysregulated in adenomas. This study has provided evidence of increased inflammation within pre-malignant colonic adenomas. This may allow potential mechanistic pathways in the initiation and promotion of early colorectal carcinogenesis to be identified.

A patient with four metachronous cancers and multiple adenomatous colon polyps harboring the American Founder Lynch syndrome mutation: a case report

Background Lynch syndrome (LS) is a genetic disorder that accounts for approximately 3% of all colorectal cancers (CRC) [1]. Clinical characteristics of LS include proximal CRC, multiple CRCs, occurrence at a young age, accelerated carcinogenesis, and an increase in risk of extracolonic cancers [1]. LS is an autosomal dominant disorder, caused by germline mutations in DNA mismatch repair (MMR) genes. Mutations in MSH2 account for 1-2% of all CRCs and up to 20% of these are large germline deletions [2]. The MSH2 deletion of exons 1-6 has been characterized as a North American Founder Mutation (AFM) [2,3].

TAS2R38 bitter taste genetics, dietary vitamin C, and both natural and synthetic dietary folic acid predict folate status, a key micronutrient in the pathoaetiology of adenomatous polyps

Taste perception may influence dietary preferences and nutrient intakes contributing to diet-related disease susceptibility. This study examined bitter taste genetics and whether variation in the TAS2R38 gene at three polymorphic loci (A49P, V262A and I296V) could alter dietary and systemic folate levels and dietary vitamin C intake, and whether a nutrigenetic circuit existed that might link bitter taste, folate/antioxidant status and risk for a colonic adenomatous polyp. TAS2R38 diplotype predicted bitter taste (PROP) phenotype (p value <0.00001) and red cell folate status (p=0.0179) consistent with the diplotype that has the broadest range of bitter perception (AVI/PAV) also possessing the highest average red cell folate value. However, TAS2R38 diplotype did not predict dietary intake of methylfolic acid, pteroylmonoglutamic acid or total folic acid. Neither did it predict dietary intake of vitamin C. Despite this, intake of dietary folate predicts red cell folate with analysis pointing to a key nutrient-nutrient interaction between vitamin C intake and systemic folate status. Analysis of 38 patients with an adenomatous polyp and 164 controls showed that individually, dietary nutrient intake, nutrient status and taste diplotype did not influence polyp risk. However, red cell folate status (in individuals below the population median value) did interact with bitter taste diplotype (AVI/PAV) to predict polyp risk (p=0.0145). Furthermore, synthetic folic acid (below median intake) was statistically associated with adenoma occurrence (p=0.0215); individuals with adenomatous polyps had a 1.77× higher intake than controls. Additionally, stepwise regression taking account of all dietary nutrients showed a tight relationship between methylfolic acid (but not pteroylmonoglutamic acid) intake and red cell folate level in those with a low folate status and occurrence of an adenomatous polyp (p=0.0039). These findings point to a role for folate in the pathoaetiology of adenomatous polyps, with the natural and synthetic vitamers not necessarily having the same biological effect.

Prevalence of MYH-associated polyposis related to three recurrent mutations in Morocco

Background: MYH-associated polyposis (MAP) is an autosomal recessive inherited disease. People with MAP tend to develop multiple adenomatous colon polyps during their lifetime and have an increased risk of colorectal cancer. MAP has only recently been described and there is much to be learned about the condition. Recessively inherited mutations in the base excision repair gene MYH have recently been associated with predisposition to colorectal adenomas and cancer. The epidemiology of MYH-associated polyposis (MAP) is poorly known in populations with high levels of consanguinity like North African populations, in particular in Morocco, and the MAP carrier frequency in the general Moroccan population has never been evaluated. The present study was carried out among the Moroccan population, using molecular epidemiology methods, to estimate the prevalence of homozygote or compound heterozygote genotype conferring MAP due to three mutations reported as recurrent in MAP: c.494A>G (Y165C), c.1145G>A (G382D) and c.1186_1187insGG (p.Glu396fsX42).Methods: To estimate the prevalence of MYH mutations in Morocco, DNA extracted from blood samples of 400 healthy Moroccans was tested for recurrent MYH mutations using real-time PCR or DNA fragment analysis. Heterozygotes profiles were confirmed by direct sequencing. We searched for the mutations c.494A>G and c.1145G>A in 400 subjects, and the mutation c.1186_1187insGG in 250 subjects.Results: One subject was heterozygous for c.494A>G (1/400 or 0.25%), three others for c.1145G>A (3/400 or 0.75%) and one was heterozygous for p.Glu396fsX42 (1/250 or 0.4%). The carrier frequency of one of these three mutations in the Moroccan population was calculated to be 1.4% and the frequency of homozygous or compound heterozygote for these three recurrent mutations is 1/10 000.These figures allowed one to estimate at 3500 the number of Moroccans with high risk of developing colon cancer due only to these three recurrent mutations.Conclusion: This preliminary study shows that the Moroccan population is at risk for MAP. This could help to define diagnosis strategies and patient care and may also have implications for genetic counselling.

Streptococcus bovis bacteremia as a Complication of Colonoscopy

Purpose: Infectious complications of colonoscopy are uncommon. The most common type is bacteremia, which is usually transient and does not cause symptoms. The most common organisms causing bacteremia are the indigenous gut flora. Streptoccus bovis is one of the normal inhabitants of the human gastrointestinal tract. Reported cases of Streptococcus bovis bacteremia are usually in association with colon cancer or infective endocarditis, although there are also reports that suggest that it may occur in association with adenomatous colon polyps. We report a case of a patient who has no colon cancer or endocarditis and who developed symptomatic Streptococcus bovis bacteremia after colonoscopy and polypectomy. A 59 year old Caucasian male underwent routine colonoscopy for colorectal cancer screening. His past medical history includes chronic atrial fibrillation, diabetes mellitus and aortic stenosis. Findings on colonoscopy include four polyps, varying in size from 6 to 8 mm, which were all removed by snare cautery and hot biopsy forceps. All of these polyps were adenomas. Less than twenty four hours after colonoscopy, the patient developed high grade fever and chills. He was then admitted to the hospital. WBC count on admission was 11.9 thousand/cubic mm. Initial fever workup, including chest x-ray, urinalysis and urine culture, was unremarkable. Subsequently, Streptococcus bovis grew in the blood cultures. A transesophageal echocardiogram was done, which did not show any findings to suggest endocarditis. The patient was treated with intravenous Levofloxacin based on the sensitivity in the blood cultures. The patient's recovery was uneventful. The reported incidence of bacteremia after colonoscopy varies from 0% to 25%, with a mean frequency of 4.4%. It is postulated that mucosal trauma related to the procedure allows translocation of the normal gut flora into the bloodstream. Other factors that predispose to bacteremia include the degree of distension of the colon and the colon-cleansing method. Streptococcus bovis is a non-enterococcal group D streptococcus in the human gastrointestinal tract that can cause bacteremia and endocarditis. The association between Streptococcus bacteremia and colonic neoplasia is well-described. There are also several studies showing the relationship between Streptococcus bovis bacteremia and other non-malignant gastrointestinal diseases, including colonic adenomas. In our case, the patient did not have colon cancer or endocarditis but he had several adenomatous colon polyps. The combination of mucosal trauma from colonoscopy and the presence of colonic adenomas most likely contributed to the development of Streptococcus bovis bacteremia in this patient.

PP11 INTESTINAL INFLAMMATION AND INTESTINAL MICROBIOTA COMPOSITION IN CHILDREN WITH CYSTIC FIBROSIS

reversed 2 months later. Post-operative follow-up (1-3-6 months) included a clinical, nutritional haematological and biochemical examination. Results: Pre-operatively 1 patient was asymptomatic; 1 patient presented with hematochezia; 1 patient suffered abdominal pain. All patients had hundreds of colonic adenomatous polyps with mild dysplasia; 2 patients had gastric polyps; 1 patient ileal polyps; 1 patient had echo-structural thyroid abnormalities remaining euthyroid. No intra-operative or early post-operative complications occurred. Fifteen days post-operatively, 1 patient had partial small bowel obstruction caused by intestinal infection. After closure of ileostomies, all patients had voluntary bowel movements (mean: 4 movements/day) and no soiling, improving with diet and psyllium. A gradual weight increase was observed in 2 patients. Conclusions: Laparoscopic total colectomy with transanal rectal mucosectomy assures a low rate of complications, good functional outcome and excellent cosmetic results.

Clinical and Pathologic Correlation of Colonic Adenomatous Polyps in Nation-Wide Ambulatory Endoscopy Centers

Clinical and Pathologic Correlation of Colonic Adenomatous Polyps in Nation-Wide Ambulatory Endoscopy Centers

A case of Cronkhite–Canada syndrome presenting with adenomatous and inflammatory colon polyps

A 72-year-old man was referred for evaluation of dysgeusia, diarrhea and anorexia. 3 months prior he began to experience taste changes, a decline in appetite and 3-7 loose, non-bloody stools per day. Nausea and lower abdominal cramping subsequently developed and he lost 22.68 kg in weight. His past medical history included atrial fibrillation treated with anticoagulation and digoxin. In the past, he had experienced markedly increased levels of triglycerides and was being treated for this condition with a lipid-lowering agent. There was no family history of colorectal neoplasia or IBD. He was a non-smoker and did not drink alcoholic beverages. Medical history, physical examination, laboratory evaluation (including 72 h stool collection), upper endoscopy, colonoscopy and histologic analysis of biopsy samples. Cronkhite-Canada syndrome. Prednisone (40 mg orally once daily, eventually tapered to 10 mg orally once daily), a histamine-2-receptor blocker and oral micronutrient supplementation (iron, vitamins A, E and D and a multivitamin). Removal of all visible polyps from the anal verge to 25 cm endoscopically by snare polypectomy or with hot biopsy forceps, followed by subtotal colectomy with end-to-side ileorectostomy.

Repeated colonoscopic screening of patients with acromegaly: 15-year experience identifies those at risk of new colonic neoplasia and allows for effective screening guidelines

It is suggested that patients with acromegaly have an increased risk of colorectal cancer and pre-malignant adenomatous polyps. However, the optimum frequency with which colonoscopic screening should be offered remains unclear. To determine the optimum frequency for repeated colonoscopic surveillance of acromegalic patients. We retrospectively reviewed the case records of all patients with acromegaly seen in our centre since 1992: 254 patients had at least one surveillance colonoscopy, 156 patients had a second surveillance colonoscopy, 60 patients had a third surveillance colonoscopy and 15 patients had a fourth surveillance colonoscopy. The presence of hyperplastic or adenomatous polyps was assessed in all patients, while one cancer was detected at the second surveillance. At the third surveillance, mean (+/-s.d.) serum IGF1 levels (ng/ml) in patients with hyperplastic polyps were significantly higher than those with normal colons (P<0.05). The presence of an adenoma rather than a normal colon at the first colonoscopy was associated with a significantly increased risk of adenoma at the second (odds ratio (OR) 4.4, 95% confidence interval (CI) 1.9-10.4) and at the third (OR 8.8, 95% CI 2.9-26.5) screens. Conversely, a normal colon at the first surveillance gave a high chance of normal findings at the second (78%) or third surveillance (78%), and a normal colon at the second colonoscopy was associated with normality at the third colonoscopy (81%). Repeated colonoscopic screening of patients with acromegaly demonstrated a high prevalence of new adenomatous and hyperplastic colonic polyps, dependent on both the occurrence of previous polyps and elevated IGF1 levels.

142 Increase in Body Size is Associated With an Increased Incidence of Advanced Adenomatous Colon Polyps in Male Veteran Patients

142 Increase in Body Size is Associated With an Increased Incidence of Advanced Adenomatous Colon Polyps in Male Veteran Patients

T1045 Chronic Diabetic Complications are Associated With an Increased Incidence of Advanced Adenomatous Colon Polyps in a Male Veteran Population

T1045 Chronic Diabetic Complications are Associated With an Increased Incidence of Advanced Adenomatous Colon Polyps in a Male Veteran Population

T1053 Cirrhosis is Associated With an Increased Prevalence of Advanced Adenomatous Colon Polyps in Male Veteran Patients

T1053 Cirrhosis is Associated With an Increased Prevalence of Advanced Adenomatous Colon Polyps in Male Veteran Patients

T1158 Ameliorating Intestinal Inflammation and Preventing Colon Tumor Development by the Plant Extract, Berberine

Background. Berberine, an isoquinoline alkaloid derived from plants, has been used as a traditional medicine for several diseases, including bacterial diarrhea. Recently, Berberine has been shown to suppress tumor cell growth and regulate several signaling pathways involved in apoptosis and cell cycle arrest In Vitro. However information is limited regarding mechanisms of Berberine's action in diseases. This study was designed to investigate Berberine's anti-tumor and anti-inflammatory effects. Methods. 7 patients with familial adenomatous polyposis history and recurrent colon adenomatous polyps were enrolled for oral Berberine treatment (0.1 g, 3 times/day) immediately following polypectomy and patients followed-up up to two years. Animal studies were performed on C57BL/6 mice administered 3% DSS in drinking water, or water only, for 7 days. Mice were given Berberine (200 μg/ g body weight, once daily) via gavage from day 4-7. Colon sections were prepared for H&E staining to determine intestinal tissue injury score (0: normal, 18: severe colitis). Mouse colon epithelial cells derived from wt Immorto (YAMC), Immorto-Min mice carrying APC min mutation (IMCE), and IMCE cells over-expression of Ras (IRas) were treated with Berberine (25 μM 200 μM) in the presence or absence of TNF (100 ng/ml), EGF (10 ng/ ml) or caspase inhibitor for detecting apoptosis using Annexin staining and TUNEL assay, signaling by Western blot analysis, and colony formation in agar. Results. 6 (7 total) patients showed no recurrence of polyps during the 2-year Berberine treatment. Berberine induced apoptosis in IMCE and IRas, but not YAMC cells and inhibited IRas cell colony formation in a concentration-dependent manner. Berberine stimulated p53 activation and blocked TNF-induced NFκB activation. In addition, Berberine inhibited EGF-stimulated EGF receptor activation and cell proliferation. However, Berbeine did not activate caspase 3 or 9 nor did the caspase inhibitor prevent Berberine-induced apoptosis. DSS-induced colitis (score: 15±0.9) was significantly reduced by Berberine treatment (score: 10±1.3, p<0.05). Conclusion. Berberine exerts the anti-tumor effect, which may be through induction of tumor cell apoptosis and inhibition of the action of tumor-promoting factors, including EGF and TNF. In addition, anti-inflammatory effects of Berberine may contribute to prevention of colitisassociated tumor development. The role of p53 activation and NFκB inhibition by Berberine in prevention of tumor development and inflammation is under investigation. Thus, Berberine may serve as a potential alternative approach for treating intestinal inflammatory diseases and tumor development.

Abstract 5145: The niche architecture and nuclear structure of cancer stem cells

Abstract Background: Cell nuclei with fulgen-negative round areas of uniform diameter in the buccal mucosa were first reported by the author in 1962 as reflections of a primary malignant tumor in a distant site as well as in precursor lesions of the uterine cervix. These cells were designated as a malignancy-associated change (MAC). The origin of these cells was unknown. However, recent observations reveal that the nuclear structure of cancer stem cells is identical to MAC cell morphology. The nuclear pattern originally identified as MAC denotes a cancer stem cell at a distance from the primary tumor. Methods: This coincidental finding led to the review of 76 histologic sections of adenomatous colonic polyps, 60 specimens of peripheral blood and 299 buccal mucosal spreads. Evaluation of the cell nuclear structure was made by utilization of the highest microscopic magnification (100x objective, 10x ocular, tube length 1.25). Results: Review of the MAC cases revealed the cancer stem cell microenvironment with asymmetric cell division. The stem cell niche has a well organized but variable micro-environmental architecture depending upon developmental stages within the niche. Self-renewal daughter and progenitor cells were characterized by identical cribriform nuclear structure in fulgen-negative stained and hematoxylin-eosin unstained spherical areas with uniform diameters. These malignancy-associated stem/progenitor cells were identified in 19 of 28 cases of colonic adenomatous polyps with focal carcinoma at sensitivity of 68%, specificity 88%. Peripheral blood cells with identical nuclear pattern were observed as a manifestation of carcinomas of the bladder, kidney and prostate in 23 of 29 cases at sensitivity 79%, specificity 80%. In buccal mucosa specimens an identical nuclear pattern was noted in 112 of 145 cases at sensitivity 77%, specificity 86% as a reflection of tumors in the lung, urogenital and gastrointestinal tract. Discussion: The specific uniform nuclear structure in cells of the colon, peripheral blood and buccal mucosa distant from the primary tumor were identified as cancer stem cells. Self-renewal and progenitor cells in asymmetric division have an identical specific nuclear structure and retain their precise nuclear pattern during their migration and final destination at distant sites. The nuclear-specific structure of these cells permits not only their identification but also their role as a reflection of a primary tumor at a different site. Conclusion: Examination at the highest magnification of the light microscope revealed precise nuclear structure of self-renewal and progenitor cells. Visualization of the cancer stem cell niche architecture and of the stem cell specific nuclear structure offers additional parameters for identification of stem/progenitor cell morphology, migration pathways and detection of cancer manifestation in sites distant from the primary tumor. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5145.

FDA Approves a Statin Therapy for Some

avoid dairy products. In addition to the obvious concerns about bone health, the panel noted that recent research has linked increased calcium intake with reduced blood pressure, a lower risk of adenomatous colon polyps, and higher production of such fatty acids as butyrate that may promote mucosal growth and reduce inflammation. Daniel Swagerty, MD, MPH, professor of family medicine and internal medicine at the University of Kansas School of Medicine in Kansas City, said the panel’s work points out the importance of patients receiving a proper diagnosis from a physician rather than just assuming theyhave lactose intoleranceandsubsequently avoiding dairy products. “A significant number of people are denying themselves food and supplements they should have, and that’s a real risk in terms of lifelong health and wellness,” said Swagerty, who was not part of the conference. Nicholas Talley, MD, a gastroenterologist who is chair of internal medicine at the Mayo Clinic in Jacksonville, Fla, echoed the panel’s concerns about the scarcity of data on the prevalence of lactose intolerance and the potential health risks of avoiding dairy products that are rich in calcium and vitamin D. “As a researcher and a clinician, I’d like to know how many of my patients have lactose intolerance,” said Talley, who also was not involved with the panel’s work. “But the real question is not just what’s the prevalence of lactase deficiency, but what’s the prevalence of clinically relevant lactose intolerance and the prevalence of complications of lactose intolerance from the lack of dietary factors. That’s what we don’t know.”

Differences in the prevalence of colorectal polyps in patients undergoing endoscopic removal of gastric adenoma or early gastric cancer and in healthy individuals

We compared the prevalence of adenomatous and cancerous colon polyps in patients who underwent endoscopic removal of gastric neoplasms and in healthy controls. This retrospective study reviewed the medical records of 186 patients with gastric neoplasms and 186 healthy subjects from January 2002 to October 2008. The gastric neoplasm group was comprised of patients undergoing endoscopic removal of gastric adenomas or early gastric cancers and serial fiberoptic colonoscopy (FCS) for checkups. The control group was comprised of subjects undergoing fiberoptic esophagogastroduodenoscopy (FEGD) and FCS for general checkup and was matched for age and sex with the gastric neoplasm group. Advanced colonic neoplasm was defined by any of the following: (1) the presence of three or more polyps; (2) polyp size at least 1.0 cm; (3) high-grade dysplasia or adenocarcinoma confirmed by histopathologic examination. Of the 372 persons, colorectal polyps were detected in 124 (33.3 %), advanced colonic neoplasms in 44 (11.8 %), and adenocarcinomas in 10 (2.7 %). The overall prevalence of adenomatous or cancerous polyps ("all polyps") and the prevalence of advanced colonic neoplasms were significantly higher in the gastric neoplasm group than in the control group (all polyps: 40.9 % in the gastric neoplasm group vs. 25.8 % in the control group, P = 0.002; advanced colonic neoplasms: 15.6 % vs. 8.1 %, P = 0.025). The risk factors for all polyps were age, male sex, diabetes mellitus, and being assigned to the gastric neoplasm group, and those for advanced colonic neoplasms were age and being assigned to the gastric neoplasm group. Confining the analysis to the gastric neoplasm group, the risk factors for all polyps were identical with those for the total group; however, those for advanced colonic neoplasm were different (age vs. diabetes and hypertriglyceridemia). Endoscopists should consider performing routine FCS in patients undergoing endoscopic removal of gastric neoplasms.

Influence of Proton Pump Inhibitor Use in Gastrointestinal Polyps

Proton pump inhibitors (PPIs) are the most potent anti-acid agents and are extensively used worldwide. PPI-induced hypergastrinemia is one of the very few side effects associated with these drugs. However, because hypergastrinemia is related to the occurrence of colonic adenomatous polyps, the purpose of this study was to analyze the relationship between the occurrence of gastrointestinal polyps and hypergastrinemia induced by PPIs. This study included 259 patients who underwent colonoscopy and esophagogastroduodenoscopy between January and August 2007. Chart records, including medication history and fasting plasma gastrin level, were reviewed and analyzed. Any subtle polypoid lesions in the stomach and colon were sampled by biopsy for histological examination. Helicobacter pylori infection status was examined by a rapid urea test during esophagogastroduodenoscopy. All patients underwent endoscopy examinations. A total of 122 patients were receiving PPI treatment for either peptic ulcer disease or reflux esophagitis and were included as the study group. The remaining 137 patients were not treated with PPIs and served as the non-PPI group. The mean fasting gastrin level in PPI users versus non-PPI users was 121.8 ng/L versus 56.8 ng/L, respectively (p < 0.001). Although the prevalence of gastric gland polyps was higher in the PPI group (65.6% vs. 37.2%, p < 0.001), there was no difference in the prevalence of colonic adenomatous polyps observed (22.13% vs. 22.62%, p = 0.928). In conclusion, the prevalence of gastric polyps, particularly fundic gland polyps, was higher among PPI users. However, the prevalence of colonic polyps was not affected by PPI use, regardless of past history of colonic adenomatous polyps.

Aggressive gastric cancer in a patient with an APC mutation and a monoallelic MYH mutation

Familial Adenomatous Polyposis Syndrome (FAP) is an autosomal dominant inherited hereditary colorectal cancer syndrome that is characterized by hundreds to thousands of adenomatous colonic polyps and, without treatment and close surveillance, confers a high lifetime risk of colon cancer. Polyps usually develop in adolescence and virtually all will develop polyps by age 30. It is caused by a mutation in the Adenomatous Polyposis coli (APC) gene which is responsible for tumor suppression and controls apoptosis. While benign fundic gland polyps are common, gastric cancer is rare in the Western population. MYH Associated Polyposis Syndrome (MAP) is an autosomal recessive disease caused by biallelic mutations in the MYH gene which is part of the base excision repair system. Patients with MAP exhibit an attenuated form of polyposis with 10's to 100's of adenomatous polyps and have a later age of onset, typically 10 years later than FAP. Currently to be diagnosed with MAP patients must carry biallelic mutations though recent studies have described similar colon cancer risks for monoallelic carriers. We report on a case of a 65 year old woman with an APC mutation positive FAP (de novo) who also carries a monoallelic mutation in the MYH gene G382D that developed metastatic gastric cancer within a year of a clear CT scan. She had undergone a colectomy with IRA in her 20's and had been followed by yearly endoscopic surveillance that demonstrated polyps in the remaining rectum as well as adenomatous duodenal polyps and gastric polyps with no evidence of malignancy. At 61 she was converted to a I-Pouch and continued with appropriate surveillance. At age 64 Spieglman Stage III duodenal adenomatosis was detected and EGDs were done every 3 months. In March 2008 she presented to the ER with epigastric pain, hematochezia and hemetemesis following an EGD and polypectomy earlier that day. A CT of the chest, abdomen and pelvis did not reveal any abnormalities. She continued to be monitored every 3 months and in March 2009 she had progressed to Spieglman Stage IV. Biopsies were obtained from the duodenal adenomas and were negative for high grade dysplasia. Two months later a CT scan revealed abnormal nodules in the liver. A diagnosis of metastatic gastric cancer was made following further studies.