Prevalence Of Colonic Adenomas Research Articles

Outcome of Colonoscopic Screening in Potential Liver Transplant Candidates

BackgroundScreening for neoplastic lesions is mandatory as a part of the evaluation process of potential candidates for liver transplant (LT). This work aimed at identifying the main findings in screening colonoscopy and their risk factors. MethodsEndoscopic and pathologic findings of the biopsied lesions of 311 potential candidates for living donor liver transplant were collected and analyzed. ResultsColorectal polyps (8.7%) were the most common colonoscopic finding, of which 4.18% were diagnosed as adenomas. Other findings included hemorrhoids (7.7%), portal hypertensive colopathies (3.5%), angiomatous malformations (2.6%), rectal varices (1.6%), and diverticulosis (1.6%). The univariate analysis revealed that the prevalence of colonic adenoma was significant in patients 50 years and older (P = .03; odds ratio, 1.178; 95% CI, 1.016-1.365) and in patients who had hepatocellular carcinoma (P = .043; odds ratio, 6.5; 95% CI, 1.002-42.172). In the multivariate analysis, age was found to be the single best predictor of the presence of adenoma (P = .044; odds ratio, 1.178; 95% CI, 1.005-1.382). ConclusionWe can conclude that a screening colonoscopy prior to liver donor liver transplant should be performed at least in every LT candidate 50 years or older. Colonic polyps were the most common findings on screening colonoscopy prior to LT.

Obesity Increases Prevalence of Colonic Adenomas at Screening Colonoscopy: A Canadian Community-Based Study.

Background and Aims Obesity is a risk factor for colorectal neoplasia. We examined the influence of obesity and metabolic syndrome (MetS) on prevalence of neoplasia at screening colonoscopy. Methods We evaluated 2020 subjects undergoing first screening colonoscopy. Body mass index (BMI) was calculated at enrolment. Hyperlipidemia (HL), hypertension (HT), and diabetes mellitus (DM) were identified. Details of colonoscopy, polypectomy, and histology were recorded. Odds for adenomas (A) and advanced adenomas (ADV) in overweight (BMI 25.1–30) and obese (BMI > 30) subjects were assessed by multinomial regression, adjusted for covariates. Analyses included relationships between HL, HT, DM, age, tobacco usage, and neoplasia. Discriminatory power of HT, HL, DM, and BMI for neoplasia was assessed by binary logistic regression. Odds were calculated for neoplasia in each colonic segment related to BMI. Results A and ADV were commoner in overweight and obese males, obese females, older subjects, and smokers. HL, HT, and DM were associated with increased odds for neoplasia, significantly for A with hypertension. BMI alone predicted neoplasia as well as HT, HL, DM, or combinations thereof. All segments of the colon were affected. Multiple polyps were particularly prevalent in the obese. Conclusions Obesity and MetS are risk factors for colonic neoplasia in a Canadian population.

Prevalence of Colonic Adenoma Is Nearly 60% in South Central Minnesota

Introduction: The prevalence of colonic adenoma has been previously reported to be more than 50%. Over the past 3.5 years, our group has recorded over 6,000 colonoscopies to calculate adenoma detection rate (ADR) for each physician. Withdraw time, adenoma pathology, polyp size, indication, age, and gender were documented systematically. The overall ADR was 57%. For the indication of screening, the ADR was 58%. For those patients that previously had adenoma, the ADR was even higher at 71%. Therefore, we conclude that the prevalence of colonic adenoma is nearly 60% in our region. Methods: Between July 2010 and December 2013, our group has systematically recorded the colonoscopy withdraw time, insertion time, adenoma pathology, polyp size, number of adenomas, age, gender for every colonoscopy performed. The data were entered manually in a Microsoft Excel file. The pathology report was matched to each colonoscopy report. The data were exported into SAS version 8.2 for analysis and computation. Results: A total of 6,179 colonoscopies were recorded during the 3.5-year study period. Overall ADR during this period was 57.1%. For purely screening indication, the ADR was 57.8%. The ADR was very high at 71.2% for individuals with previous polyp or colon cancer. Conclusion: Prevalence of colonic adenoma is nearly 60% in our region of South Central Minnesota. For individuals with previous colon polyp or colon cancer, the ADR is even higher at 71%. The average scope withdraw time is about 23 minutes in our group.Table 1Table 2: Breakdown ADR Per Each Indication

High Prevalence of Colon Adenomas in End Stage Renal Disease Patients on Hemodialysis Undergoing Renal Transplant Evaluation

High Prevalence of Colon Adenomas in End Stage Renal Disease Patients on Hemodialysis Undergoing Renal Transplant Evaluation

Abstract 3710: Targeted inhibition of arginase-1 may underline the suppression of the development of colonic neoplasia in a transgenic APC Min mouse model.

Abstract Colorectal cancer (CRC) is the third-leading malignancy in the United States. This year alone, about 141,210 new cases of colorectal cancer will be diagnosed and more than 49,380 people will die from the disease. Strategies have focused on early screening practices and the prevention of the development of colonic adenomas that serve as precursors of invasive colon cancers. We have recently showed that chloroquine (CQ) an anti-malarial and anti-rheumatoid agent has the capacity to competitively inhibit intracellular arginase-1 (ARG-1) and that this inhibition increases the nuclear localization of the cell cycle regulator p53 protein in colon cancer cell lines. However, the mechanism of CQ-induced inhibition of ARG-1 that results in the up-regulation of p53 is unclear. The goal of the current study was to examine the chemopreventive efficacy of CQ in the development of colonic neoplasia and to further evaluate the possible mechanism(s) of action. In this regard, six weeks old Apc(Min/+) mice were treated daily (except Saturdays and Sundays) with 0-50 mg CQ/kg body wt. via oral gavage for forty days. Post-treatment, mice were sacrificed and jejunum and colon were retrieved and preserved in 10% formalin for observation of any gross pathological changes. The results of this study showed an increased in prevalence of colonic adenomas in untreated mice compared with treated mice (< 0.05). Interestingly, histochemical analysis showed significant numbers of adenomas with high-grade dysplasia (as evidenced by the presence of increased fibrous tissue core) in untreated control mice in comparison with drug-treated mice (<0.05).Since emerging studies have identified the overexpression of ARG-1 in a variety of human malignancies, including cancer of the colon, we then investigated the impact of CQ on ARG-1 levels. To this end, HT-29 cells were co-incubated with CQ (0-50 μM) for 24 h and the levels of ARG-1 were determined by western blot assay. Surprisingly, our result showed that CQ-induced inhibition of ARG-1 level corresponded to the diminution of β-catenin protein via to its phosphorylation. Further immuno- fluorescence analysis showed an increased level of nuclear localization of GFP tagged p53 (GFP-p53) and p21 in transiently transfected HT-29 cells upon CQ treatment. The observation that targeting ARG-1 results in a corresponding decrease in β-catenin level is intriguing, since the Wnt/β-catenin signaling is fundamental to colon carcinogenesis and spontaneous tumorigenesis in Apc(Min/+) mice and patients with familial adenomatous polyposis.In conclusion, our cumulative findings indicate that CQ ameliorates the development of colonic neoplasia and that the inhibition of ARG-1 and β-catenin may contribute to its chemopreventive effects in intestinal tumorigenesis. Citation Format: Efe W. Iyamu, Mohammad S. Niaz, Aramandla Ramesh, Amos Sakwe, Kieosha Williams, Billy R. Ballard, Samuel E. Adunyah. Targeted inhibition of arginase-1 may underline the suppression of the development of colonic neoplasia in a transgenic APC Min mouse model. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3710. doi:10.1158/1538-7445.AM2013-3710

A Retrospective Look at The Relationship Between Metabolic Factors, Obesity, and Colorectal Adenomas in a Racially Diverse Community Hospital

Purpose: The objective of this retrospective study is to examine the relationship between the prevalence of colonic adenomas and BMI and/or metabolic factors among our racially diverse population. Methods: After excluding patients with colon cancer, inflammatory bowel disease, family history of GI malignancy, we randomly reviewed the charts of a total of 779 patients who underwent screening colonoscopies from 2009 to 2011. Statistical analyses were preformed using Chi-Square for categorical variables and a t-test for continuous variables; and age-, gender- and race-adjusted odds ratios and their 95% confidence intervals (CIs) between BMI, metabolic disorders, smoking and alcohol with the presence of colonic adenomas were estimated using unconditional logistic regression models. Results: Colorectal adenomas were detected in 167 out of 779 (21.4%) patients undergoing screening colonoscopies. The predominant race in our patient population undergoing screening colonoscopies in respective order: hispanic (334), black (272), white (107), and other (58) (p<0.05) Black race represented the greatest percentage of patients found to have adenomatous polyps (40.2%), whereas the hispanic population was found to represent the greatest number in the non-adenomatous group (46.2%) (p<0.05). when comparing BMI groups 1 & 2, 2 & 3, and 1 & 3, no statistical significance was found between adenomas and increased BMI 1.41(95% CI, 0.84-2.39; p>0.05), 0.96(95% CI, 0.65-1.41; p>0.05), and 1.35(95% CI, 0.80-2.29; p>0.05) respectively. Metabolic factors (diabetes, hypertension, and dyslipidemia) failed to show any statistical significant correlation with adenoma presence 0.68(95% CI, 0.43-1.07;p>0.05) in those diagnosed with diabetes, 1.09(95% CI, 0.75-1.58; p>0.05) in hypertension, and 0.88(95% CI, 0.61-1.29; p>0.05) with dyslipidemia. Hispanics were found to have a less likelihood of having adenoma present on screening colonoscopy 0.52(95% CI, 0.31-0.88; p<0.05). There was no significant statistical difference between black and whites 0.75(CI 95%, 0.45-1.25; p>0.05), or other race compared to whites 0.62(CI 95%, 0.28-1.38; p>0.05). Smoking compared did appear to be correlated with colorectal adenoma 1.57(95% CI, 1.02-2.43; p<0.05). Conclusion: In our population we found evidence that BMI is not a risk factor for colonic adenoma. We also concluded that diabetes, dyslipidemia, and hypertension showed no statistical correlation with incidence of colorectal adenoma. We did not find either dose-response effect or association of individual components of metabolic factors. Our study did find an association between the risk of smoking and adenomas. When looking at race the Hispanics showed a lower incidence of colorectal adenoma presence than white population.Table: [531] Individual associations between metabolic factors, environmental factors and adenomaTable: [531] Association between prevalence of adenoma versus metabolic factors in Screening Colonoscopies

High Prevalence of Colonic Adenoma in Patients with End-Stage Renal Disease (ESRD) on Hemodialysis (HD) Undergoing Renal Transplant (RT) Evaluation

High Prevalence of Colonic Adenoma in Patients with End-Stage Renal Disease (ESRD) on Hemodialysis (HD) Undergoing Renal Transplant (RT) Evaluation

Colorectal Cancer Risks are Increased in Filipino-Americans: A Community Based Study in Las Vegas, NV

Purpose: Colorectal cancer (CRC) is the third most commonly diagnosed cancer, and second most common cause of cancer death. There is substantial evidence that CRC screening is effective in reducing incidence and mortality from this disease and this has been attributed to early detection and removal of adenomatous polyps. Recently, population based epidemiological studies revealed differences in incidence and morbidity. In particular, Filipino-Americans were more likely to be diagnosed in the more advanced stages of CRC as compared to other Asian subpopulations. The aim of this study is to describe possible factors that may lead to increased risks for colon cancer among Filipino-Americans that underwent CRC screening in Las Vegas, NV. Methods: A total of 1186 patients were seen for CRC screening from September 1, 2009 to April 30, 2011. Of these patients, those who: 1) previously had colonoscopy in the past 10 years for colon cancer screening, 2) previous history of colon adenomas, 3) family history of colon adenoma or cancer, and 4) age range beyond 50 to 75 years old; were all excluded. Race/ethnicity information were based primarily on self identification by the patient and/or by the medical personnel. “Filipino” patients included in this study were all born in the Philippines and are residents of the United States. “Non-Filipino” patients include those not born in the Philippines, specifically those who are Caucasian, Hispanic, African-Americans and other mixed races, and all residents of the United States. Presence of colon adenomas were determined from histopathology records, and location was determined from endoscopy records. Results: A total of 826 patients were included in the study. The age range was 50-75 years old, with mean of 60.4 years (59.9-60.9). Filipinos were sent for CRC screening later than Non-Filipinos, 60.9±0.3 years vs. 59.6±0.4 years, p < 0.008. The prevalence of colon adenomas are in Table 1. There is a significant increase in adenoma detection in Filipino males, compared to other groups, p < 0.02. There is a 3.9 (1.4-11) odds that a Filipino male will have colon adenoma as compared to Non-Filipino male, p < 0.01.Table: Prevalence of Colon AdenomaConclusion: The delay in CRC screening amongst Filipinos may be reflective of cultural health-belief attitudes toward cancer prevention. However, the increase in prevalence of colon adenomas in Filipino males suggest possible multifactorial causes (e.g, genetic) which may contribute to increased risk for colon cancer in Filipinos. In addition to increased efforts in targeting Filipino-Americans for CRC prevention, our study suggest that present CRC screening guidelines may need to consider that certain ethnic subpopulations may be at higher risk for colon adenoma and cancer.

Prevalence of colonic adenomas in patients with nonalcoholic fatty liver disease

Epidemiologic data suggest that colonic adenomas have an increased tendency to occur in patients who are obese, African American, or have a positive family history of colon cancer, or diabetes mellitus. Recent data suggest that impaired glucose tolerance, dyslipidemia, and metabolic syndrome are associated with a higher risk for colonic adenomas. Patients with nonalcoholic fatty liver disease (NAFLD) often share several of the aforementioned risk factors for colonic adenomas. However, data are lacking about the relationship between NAFLD and colonic adenomas. The aim of this study was to systematically evaluate whether NAFLD is an independent risk factor for colonic adenomas. We performed a retrospective cohort observational study on 233 patients who underwent screening colonoscopies at Brooke Army Medical Center from November 2007 to March 2010 to assess for the association between NAFLD and colonic adenomas. Patients who had previously been found to have biopsy-proven simple steatosis (n = 65) or nonalcoholic steatohepatitis (NASH) (n = 29) were compared with a control group without fatty liver disease on sonographic imaging (n = 139). Patients were stratified based on gender, race, body mass index (BMI), and family history and adjusted for variables previously known to be associated with increased adenoma risk. The mean age was 54.7 ± 6.0 years (48.5% women). Racial demographics were: 62.7% White, 18.5% Hispanic, 13.7%, African American, and 5.2% other. The mean BMI was 29.7 ± 5.8. The prevalence of colonic adenomas was 25.1% in the control group and 24.4% in the NAFLD group to include simple steatosis and NASH (p = 1.00). Furthermore, when adjusting for known confounders to include race, BMI, and family history no significant differences were found (p = 0.33). However, the ultrasound-negative patients ranked lower in the number of adenomas per person (p = 0.016). There was no difference in the prevalence of colonic adenomas when comparing the NAFLD group who had undergone colonoscopy with a group of control patients without NAFLD who had undergone colonoscopy. However, patients with negative ultrasounds appeared to have a lower polyp burden.

S1112 The Association Between Obesity and Prevalence of Colonic Adenoma According to Estrogen Environment: A KASID (Korean Association for the Study of Intestinal Disease) Study

S1112 The Association Between Obesity and Prevalence of Colonic Adenoma According to Estrogen Environment: A KASID (Korean Association for the Study of Intestinal Disease) Study

There is no increased risk for colorectal cancer and adenomas in patients with diverticulitis: a retrospective longitudinal study

This study was designed to assess the relationship between diverticulitis and the development of colorectal cancer (CRC) and colonic adenomas. A retrospective study was longitudinally conducted. Patients who had been admitted to the hospital between 1990 and 2000 with diverticulitis were retrieved and the incidence of CRC and prevalence of colonic adenomas in these patients was determined. Data were collected from the electronic clinical and pathology records. The incidence of CRC and prevalence of adenomas in this patient cohort was compared with the general population. The patients were followed until 2008. A total of 288 patients with diverticulitis were included (167 of whom were female patients [58%]). The mean age of patients at admittance for diverticulitis was 66 years (range: 27-92). CRC was detected in five patients (1.7%) (95% CI 0.8-3.5) with a mean age of 77 years; colonic adenomas were found in 18 patients (6.3%) (95% CI 4.3-9.0) with a mean age of 62 years. The lifetime risks of developing CRC and adenomas were presumed to be 4% and 20% respectively. Expected rates for CRC and adenomas in our patients were calculated as 17 (95% CI 4.0-8.6) and 69 patients (95% CI 20.1-28.3) respectively. This study showed a lower prevalence of CRC and colonic adenomas in patients with diverticulitis compared with the lifetime risk which means that diverticulitis is not a risk factor for development of CRC and adenomas. Long-term colonic screening after a negative colonoscopy for diverticulitis (generally performed several weeks after recovery) does not seem to be justified.

Prospective Evaluation of the Upper and Lower Gastrointestinal Tract in Young Patients with Iron Deficiency Anemia

Background: Although gastrointestinal (GI) endoscopy is standard of care to evaluate iron deficiency anemia (IDA) in patients who are ≥50 years old, the approach to younger patients with IDA remains unclear. The aims of this study were to describe the frequency, type, and distribution of clinically important GI lesions in young patients with IDA. Methods: Consecutive patients who were referred for the evaluation of IDA were prospectively enrolled at a single medical center. Patients were interviewed by a research assistant who obtained detailed demographic and clinical data, and all subjects had same-day EGD and colonoscopy. Iron deficiency was defined as a transferrin saturation of <15% and a ferritin of <20 ug/L, whereas anemia was defined as a hemoglobin of <13 g/dL in men and <12 g/dL in women. Lesions were classified as clinically important according to predetermined standardized criteria. Patients were stratified into 3 groups according to age: <50 years, 50 - 69 years, and ≥70 years of age. Results: A total of 1,432 patients with IDA were enrolled, including 272 <50 years old, 463 ages 50 - 69, and 697 patients ≥70 years of age. There were no differences in sex or race/ethnicity between the 3 groups. The prevalence of one or more clinically important lesions anywhere in the GI tract was lower in younger subjects (49.6% vs. 65.0% vs. 63.6%, p = 0.001). The prevalence of clinically important lesions in the lower GI tract (31.3% vs. 41.7% vs. 48.1%, p = 0.003), the proportion of subjects with colonic lesions proximal to the splenic flexure (18.8% vs. 22.9% vs. 28.1%, p = 0.001), and the frequency of synchronous lesions in the upper and lower GI tract (10.3% vs. 13.2% vs. 19.7%, p <0.001) all increased with age. In contrast, the frequency of lesions in the upper GI tract did not increase significantly with age (28.7% vs. 36.5% vs. 35.2%, p = 0.13). As age increased, there was an increase in the prevalence of colonic adenomas ≥1 cm (20.2% vs. 25.3% vs. 29.3%, p = 0.003), colorectal cancer (6.3% vs. 12.1% vs. 12.8%, p = 0.009), colonic vascular ectasias (2.2% vs. 4.1% vs. 7.6%, p <0.001), esophageal adenocarcinoma (0.0% vs. 0.4% vs. 1.1%, p = 0.04), gastric adenocarcinoma (1.1% vs. 1.1%, vs. 3.0%, p = 0.02), and vascular ectasias in the upper GI tract (1.5% vs. 4.8% vs. 5.0%, p = 0.03). Conclusions: Although the prevalence of clinically important GI lesions increases with age in patients with IDA, young patients have clinically important lesions, including colorectal and gastric cancers, identified by endoscopy. These findings suggest that all patients with IDA should undergo a thorough endoscopic evaluation of the GI tract, regardless of age.

An association between obesity and the prevalence of colonic adenoma according to age and gender

Epidemiologic data on obesity as a risk factor for colonic adenoma with respect to gender have not yet been confirmed. Here, we aimed to compare the prevalence of colonic adenoma and of advanced polyps in age-stratified men and women at baseline, to examine the role of body mass index (BMI) on colonic adenoma risk according to age and gender, and to examine the influence of menopausal status. A total of 1744 asymptomatic patients (946 men, 798 women) who underwent colonoscopy for cancer screening at Ewha Mokdong Hospital, Seoul, Korea, between February and June 2005, were eligible. BMI was assessed, and histology, size, and location of the adenoma were examined for each patient. Women were interviewed for menopausal status and a history of hormone replacement therapy. A significant increase in the prevalence of colonic adenoma and of advanced polyps was found to occur with age (P for trend < 0.01). The prevalences of adenoma and advanced polyps were higher in men in most age groups (P < 0.01), but no significant difference in prevalences was observed between genderes in patients 70 years of age or older. Moreover, a positive association between BMI and the prevalence of colonic adenoma and advanced polyps was shown in relatively young individuals of both gender (men in their thirties, P < 0.05; women in their forties, P < 0.05), and premenopausal women according to hormonal status (P = 0.01). Our data suggest that obesity increases the risk of colonic adenoma in relatively young people and in premenopausal women subject to estrogen effects.

Marked Ethnic Differences in the Frequency, Type, and Distribution of Gastrointestinal Lesions in Patients with Iron Deficiency Anemia

Background: There are marked ethnic differences in the prevalence of iron deficiency anemia (IDA) in the U.S., with the frequency being highest in blacks and Hispanics. To date, however, it is not known whether there are ethnic differences in the gastrointestinal (GI) causes of IDA. The aims of this study were to evaluate ethnic variations in the frequency, type, and distribution of GI lesions in a large cohort of patients with IDA. Methods: Consecutive patients who were referred for the evaluation of IDA were prospectively enrolled at a single medical center. Patients were interviewed by a research assistant who obtained detailed demographic and clinical data, and all subjects had same-day EGD and colonoscopy. Iron deficiency was defined as a transferrin saturation of <15% and a ferritin of <20 ug/L, whereas anemia was defined as a hemoglobin of <13 g/dL in men and <12 g/dL in women. Lesions were classified as clinically important according to standard predetermined criteria. Results: A total of 1,081 patients with IDA were enrolled (406 whites, 442 blacks, 168 Hispanics, and 65 from other ethnic groups). One or more clinically important lesions were identified in 53.9% of whites, 64.7% of blacks, 63.1% of Hispanics, and 69.2% of other ethnic groups (P = 0.004). There were significant differences between whites, blacks, Hispanics, and other ethnic groups in the prevalence of clinically important lesions in the upper GI tract (32.9% vs. 32.0% vs. 43.1% vs. 53.8%, P = 0.001), lower GI tract (31.8% vs. 47.5% vs. 42.9% vs. 41.5%, P < 0.001), and in those with both upper and lower GI lesions (10.6% vs 14.6% vs. 22.8% vs. 26.2%, P < 0.001). The frequency of clinically important colonic lesions identified proximal to the splenic flexure was significantly higher (P < 0.001) in blacks (34.8%) and Hispanics (27.4%) than in whites (12.8%) or other ethnic groups (7.7%). In addition, there were significant differences in the prevalence of colonic adenomas ≥1 cm (17.5% vs. 27.1% vs. 28.6% vs. 32.3%, P = 0.001) and colorectal cancer (7.4% vs. 14.5% vs. 7.1% vs. 6.2%, P = 0.002) between whites, blacks, Hispanics, and other ethnic groups. Of those with colorectal cancer, advanced lesions (Dukes' C & D) were significantly higher (P = 0.02) in blacks (85.9%) and Hispanics (100%) than in whites (63.3%) and other ethnic groups (75.0%). Conclusions: Among patients with IDA, there are marked ethnic differences in the frequency, type, and distribution of clinically important GI lesions. These findings are important because of the high prevalence of IDA among blacks and Hispanics in the U.S., and may be helpful in guiding the appropriate GI evaluation of IDA.

American Gastroenterological Association Future Trends Committee Report: Effects of Aging of the Population on Gastroenterology Practice, Education, and Research

American Gastroenterological Association Future Trends Committee Report: Effects of Aging of the Population on Gastroenterology Practice, Education, and Research

3376 The prevalence of adenomas and colon ca on screening colonoscopys in average risk patients.

Background: It is known that screening colonoscopy has the greatest impact on colorectal CA mortality, largely because of the probability that polypectomy can prevent colon cancer in most cases; but the cost effectiveness of this policy was questioned because of the lack of data about the yield of this test in average risk patients. Methods: Screening colonoscopy is offered at our institution to average risk patients starting at the age of fifty, in compliance with latest ACS recommendation. The prevalence of colon adenomas and colon CA was compared in this group with the group of patients who underwent colonoscopy for fecal occult blood test positive (FOBT+). The statistical analysis was done between these groups by using a Chi-square and T test. Results: Group one was the screening arm and had 137 cases, Group two was the FOBT+ and had 129 cases. Patients were excluded if they have first degree relative with colon cancer, previous history of colonic neoplasms, or if they have iron deficiency anemia. No statistically significant differences in prevalence of adenomas or colon Ca was noted between these two groups; although the group size could be a factor as the projected sample size needs to reach 1000 patients in each arm for adequate statistical analysis, but the high prevalence of adenomas in average risk patients may negate the need for such sample size to reach a clinical conclusion about this recommendation. Conclusion: Screening colonoscopy is an excellent way to detect and remove colon adenomas and in our study the yield is comparable to colonoscopy in FOBT+, which may indicate that having a one in a life time colonoscopy or repeated every 10 years can be cost effective. Patient's compliance and acceptance seems to be good when they offered this screening modality instead of annual FOBT with flex sig every 3 to 5 years.

Barrett's oesophagus, oesophageal cancer and colon cancer: an explanation of the association and cancer chemopreventive potential of non-steroidal anti-inflammatory drugs.

Barrett's oesophagus is associated with an increased risk of oesophageal adenocarcinoma. In 1985, Sontag et al reported an association between Barrett's oesophagus and colorectal cancer. This association has become controversial owing to conflicting evidence. Two recent papers indicate that although the prevalence of colon adenomas is the same in persons with Barrett's oesophagus as in the rest of the population, patients have an increased risk of developing colon cancer. A biologically plausible hypothesis is presented which explains the predisposition to both oesophageal and colon cancers. This hypothesis discusses the contribution of environmental factors such as alcohol, smoking and diet. In addition, it is proposed that the increased expression of the cyclo-oxygenase 2 enzyme is central to the predisposition to both oesophageal and colon cancers. Since this enzyme is inhibited by non-steroidal anti-inflammatory drugs such as aspirin and sulindac, these drugs hold promise as cancer chemopreventive agents in Barrett's oesophagus patients. Sulindac is the most promising of these agents owing to its efficacy in regressing colon polyps in patients with familial adenomatous polyposis.

F-18 FDG uptake in colonic adenoma.

Colonic adenomas were detected with whole-body F-18 FDG PET in two asymptomatic patients. On the PET images, areas of focal FDG accumulations suggesting colonic lesions were seen. Colonoscopy showed them to be colonic polyps. A 2 cm descending colon polyp was found in one patient, and a 1.3 cm sigmoid colon polyp in the other. Endoscopic polypectomies were performed. Each polyp was diagnosed as adenoma. Colonic adenoma has clinical significance as a premalignant lesion, and is usually treatable with endoscopic polypectomy. The prevalence of colonic adenoma is not low. Experience suggests that colonic adenomas larger than 1.3 cm might be detected incidentally during whole-body PET studies. It is beneficial that bowel preparation is not required in the PET study.

Does acromegaly really predispose to an increased prevalence of gastrointestinal tumours?

The few published prospective studies suggest a strong association of colonic tumours with acromegaly, but include small numbers of patients. In addition, the upper gastrointestinal tract of these patients has never been prospectively studied. The aim of the present study was to investigate the incidence of gastric and colonic tumours in a large cohort of acromegalic patients. Acromegalic patients consecutively admitted to an Endocrinology Department for diagnosis and follow-up, were submitted to gastroscopy and colonoscopy, to identify those harbouring gastrointestinal tumours. Over a 5-year period, 54 out of 61 patients (78% with active disease) received colonoscopy and 42 out of 61 gastroscopy. No patient had a past history of gastrointestinal malignancy. All polypoid lesions found at colonoscopy and gastroscopy were separately recorded and biopsied. No case of gastrointestinal cancer or gastric polyp was discovered. Nineteen patients (35%) had 1-8 colonic polyps, including 5 (9.3%) with adenomas. When compared to patients with a normal colon, those with polyps were significantly older (44.5 +/- 14.2 vs 52.1 +/- 10.9 years, P = 0.047), but the duration of acromegaly (10.8 +/- 8.4 vs 10.9 +/- 7.1 years, P = 0.9) and the number of patients with active disease were similar in both groups. Acromegalic patients do not have an increased incidence of gastric tumours. The observed significant variation in the prevalence of colonic adenomas (9-35%, P = 0.03) and cancer (0-15%, P = 0.017), between our patients and those of the published prospective studies with similar demographic characteristics, suggest that environmental and hereditary factors may be more important than the presence of acromegaly.

Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history.

Six hundred twenty-one asymptomatic persons with negative fecal occult blood tests (ages 50-75 yr), including 496 with no known risk factors for colorectal cancer and 125 with a single first-degree relative with a history of colonic neoplasia developed after age 40, underwent screening colonoscopy. Three Dukes A cancers were detected in average-risk persons. The overall prevalence of adenomatous polyps was 27%. Multiple logistic regression analysis revealed that increasing age and male gender were both strong predictors of colonic neoplasia (p < 0.001). A positive family history of a single first-degree relative with colorectal cancer was not associated with an increased prevalence of colonic neoplasia (p = 0.29), although an effect may be present if the relative was < 60 yr at diagnosis. Overall 16% of males and 7% of women > or = 60 yr had at least one adenoma that was large (> or = 1 cm in size), villous or tubulovillous, or had grade 3 dysplasia. We conclude that the prevalence of colonic neoplasia in asymptomatic persons with negative fecal occult blood tests is substantial, particularly in elderly males. A family history of a single first-degree relative diagnosed at age > or = 60 yr with colorectal cancer is not associated with an increased prevalence of colonic adenomas.