Reduction In Polyp Size Research Articles

Biologic treatment for severe chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis.

Chronic rhinosinusitis with nasal polyps is often severe, debilitating and difficult to treat. Biologics that target key inflammatory pathways have the potential to treat this disease; this study aimed to evaluate their effectiveness. Systematic review and meta-analysis of randomised controlled trials of biologics in chronic rhinosinusitis with nasal polyps. Primary outcomes were extent of disease, objective disease severity and disease-specific quality of life, with outcomes measured at different end-of-treatment timepoints in different studies (range 16-52 weeks). Eleven trials were identified with 2035 participants. Ten studies reported change in polyp size, estimating a reduction of -1.25 in the treatment group. Six studies reported reduction in Lund-Mackay score where the pooled mean difference was -4.90. Five studies included peak nasal inspiratory flow with a pooled mean difference of 33.54, indicating improved nasal airflow. Seven studies reported change in olfactory score with an overall pooled effect of 6.56 suggesting improved olfaction. The SNOT-22 score in nine studies gave an overall pooled effect of -14.53, indicating improved quality of life. Biologics can be effective in treating nasal polyps, with reduction in polyp size and extent of disease, and improved sense of smell and quality of life. There is significant heterogeneity in the outcomes for individual biologics, highlighting the need for further studies.

Silymarin, boswellic acid and curcumin enriched dietetic formulation reduces the growth of inherited intestinal polyps in an animal model.

BACKGROUNDSome substances of plant origin have been reported to exert an effect in reducing intestinal neoplasm development, especially in animal models. Adenomatous polyposis coli multiple intestinal neoplasia - ApcMin/+ is the most studied murine model of genetic intestinal carcinogenesis.AIMTo assess whether an enriched nutritional formulation (silymarin, boswellic acid and curcumin) with proven “in vitro” and “in vivo” anti-carcinogenetic properties may prevent inherited intestinal cancer in animal model.METHODSForty adenomatous polyposis coli multiple intestinal neoplasia - ApcMin/+ mice were used for the study of cancer prevention. They were divided into two groups: 20 assumed standard and 20 enriched diet. At the 110th d animals were sacrificed. In each group, four subgroups received intraperitoneal bromodeoxyuridine injection at different times (24, 48, 72 and 96 h before the sacrifice) in order to assess epithelial turnover. Moreover, we evaluated the following parameters: Intestinal polypoid lesion number and size on autoptic tissue, dysplasia and neoplasia areas by histological examination of the whole small intestine, inflammation by histology and cytokine mRNA expression by real-time polymerase chain reaction, bromodeoxyuridine and TUNEL immuno-fluorescence for epithelial turnover and apoptosis, respectively. Additionally, we performed western blotting analysis for the expression of estrogen alpha and beta receptors, cyclin D1 and cleaved caspase 3 in normal and polypoid tissues.RESULTSCompared to standard, enriched diet reduced the total number (203 vs 416) and the mean ± SD/animal (12.6 ± 5.0 vs 26.0 ± 8.8; P < 0.001) of polypoid lesions. In enriched diet group a reduction in polyp size was observed (P < 0.001). Histological inflammation and pro-inflammatory cytokine expression were similar in both groups. Areas of low-grade dysplasia (P < 0.001) and intestinal carcinoma (IC; P < 0.001) were significantly decreased in enriched diet group. IC was observed in 100% in standard and 85% in enriched formulation assuming animals. Enriched diet showed a faster epithelial migration and an increased apoptosis in normal mucosa and low-grade dysplasia areas (P < 0.001). At western blotting, estrogen receptor beta protein was well expressed in normal mucosa of enriched and standard groups, with a more marked trend associated to the first one. Estrogen receptor alpha was similarly expressed in normal and polypoid mucosa of standard and enriched diet group. Cleaved caspase 3 showed in normal mucosa a stronger signal in enriched than in standard diet. Cyclin D1 was more expressed in standard than enriched diet group of both normal and polypoid tissue.CONCLUSIONOur results are suggestive of a chemo-preventive synergic effect of the components (silymarin, boswellic acid and curcumin) of an enriched formulation in inherited IC. This effect may be mediated by the reduction of epithelial proliferation, the increase of apoptosis and the acceleration of villous cell renewal due to dietary formulation intake.

English

Nasal polyposis is a disease entity characterized by development of benign growths arising either from the nasal mucosa or from any of the Para-nasal sinuses alone or in combination. These out growths are associated with oedema, fibrosis, reduced vascularization, decreased number of glands as well as nerve endings and damaged epithelium. The cause of nasal polyposis is not completely understood; however, it is frequently associated with asthma and intolerance to aspirin. The condition is characterized by eosinophil inflammation: approximately65% to 90% of polyps is classified histologically as eosinophilic. The symptoms of nasal polyposis include nasal obstruction, watery discharge and impairment of sense of smell. The objectives for the management of the condition include elimination or reduction in the size of polyps followed by reestablishment of an open nasal airway and nasal breathing, improvement or restoration of sense of smell and ultimately prevention of polyp recurrence. In nasal polyposis, topical nasal corticosteroids are considered the medical treatment of choice and several different intranasal corticosteroids in combination with antihistamines have been investigated with regard to both effect on symptoms and reduction in polyp size. These benefits maybe attributed at least in part, to the effect of topical corticosteroids on decreasing eosinophilic infiltration in the nasal mucosa. The objective of the present study is to evaluate the comparative efficacy of local nasal steroids alone and in combination with an

Giant Inflammatory Pseudopolyp of the Duodenum

Purpose: Duodenal polyps are an uncommon finding. Typically, duodenal polyps are frequently seen in patients with genetic syndromes such as familial adenomatous polyposis syndrome, but also may occur sporadically. Unless large enough to cause symptoms, duodenal polyps are often discovered incidentally on upper endoscopy. Once discovered, therapeutic management depends on patient symptoms, histology, and/or size of the polyp. Management may include observation, endoscopic removal, or surgery. Here, we present a case of an unusually large duodenal pseudopolyp with unique histological features. We describe the management and course of the polyp over a 3-year time period. A 59-year-old male with a past medical history significant for prior myocardial infarction, diabetes and hyperlipidemia was referred by his gastroenterologist for evaluation of a large 4 cm duodenal polyp (not involving the ampulla) that encompassed one half the circumference of his duodenal lumen. Approximately 2 weeks prior, he underwent an upper endoscopy for an upper gastrointestinal bleed (attributed to a small gastric vessel) at which time this large polyp was incidentally discovered. Review of outside pathology reports were concerning for an adenomatous polyp with low-grade dysplasia. Upon review of the biopsy specimen by a pathologist at our institution, the polyp was found to consist of benign small bowel mucosa with non-specific inflammatory and reactive epithelial atypia with no definitive dysplasia. Due to the concerning size of this duodenal polyp, the patient subsequently underwent an MRI and upper endoscopy. MRI revealed no extra duodenal involvement and once again, biopsy revealed benign duodenal mucosa with chronic inflammation and reactive changes with no dysplasia. Following these investigational tests, general surgery was subsequently consulted for recommendations concerning surgical management. Due to the benign histology of the polyp, conservative measures with close observation were recommended. Thus, a follow up EGD with EUS was performed 8 weeks later. EUS demonstrated slight involvement of the submucosa and histology revealed reactive and regenerative changes with no malignancy. The patient continued to have regular surveillance with five upper endoscopies over the past 3 years. His most recent endoscopy has revealed a significant reduction in polyp size with biopsy showing benign mucosa, normal villous architecture and no active inflammation. There has been no progression to dysplasia or malignancy. This case highlights an unusual finding of a giant inflammatory pseudopolyp with unique histological features and the role of conservative management.

Chemoprevention in Lynch syndrome

CAPP1 tested aspirin 600 mg/day and/or resistant starch 30 g/day in 200 adolescent FAP carriers. Aspirin treatment resulted in a non-significant reduction in polyp number and a significant reduction in polyp size among patients treated with aspirin for more than 1 year. CAPP2 RCT used the same interventions in 937 Lynch syndrome patients, the first RCT to have cancer prevention as the primary endpoint. Aspirin did not reduce the risk of colorectal neoplasia in a mean treatment period of 29 months but double blind post intervention follow-up has revealed 48 participants developed 53 CRCs. Per protocol analysis showed 63% fewer colon cancers with aspirin (p = 0.008) apparent from 4 years, with a similar effect on other LS cancers. Resistant starch was not beneficial at long term followup. CAPP3 will involve a double blind dose non-inferiority trial comparing 100, 300 or 600 mg daily in 3,000 gene carriers. We can now recommend aspirin in people at high risk of colorectal cancer.

Effect of long-term, low-dose clarithromycin on T helper 2 cytokines, eosinophilic cationic protein and the ‘regulated on activation, normal T cell expressed and secreted’ chemokine in the nasal secretions of patients with nasal polyposis

Little is known about the effects of macrolides on the cytokines and chemokines that modulate the function of eosinophils in nasal polyposis. Twenty-two non-allergic and 18 allergic patients with nasal polyps were administered clarithromycin 500 mg/day (single oral dose) for eight weeks. We measured the nasal secretion levels of the T helper 2 (also known as Th2) cytokines interleukin 4, 5 and 6, the 'regulated on activation, normal T cell expressed and secreted' (also known as RANTES) chemokine, and the eosinophilic cationic protein, before and after treatment. After clarithromycin treatment, we found reduced levels of the 'regulated on activation, normal T cell expressed and secreted' chemokine in samples from both non-allergic and allergic patients (p < 0.05). Clarithromycin treatment decreased the levels of eosinophilic cationic protein only in non-allergic patients (p < 0.05), and decreased the level of interleukin 6 only in allergic patients (p < 0.05). Decreased levels of the 'regulated on activation, normal T cell expressed and secreted' chemokine were associated with a reduction in polyp size both in non-allergic and allergic patients. Clarithromycin has a strong anti-inflammatory effect in nasal polyposis, but has different immunomodulatory effects in allergic and non-allergic nasal polyposis patients.

Oral and Nasal Steroids for Nasal Polyps

Oral and Nasal Steroids for Nasal Polyps

Impact of Baseline Nasal Polyp Size and Previous Surgery on Efficacy of Fluticasone Delivered with a Novel Device: A Subgroup Analysis

Little information exists on the impact of baseline polyp size and previous nasal surgery on the efficacy of intranasal steroids. This study was designed to investigate whether baseline polyp size and previous nasal surgery influence the efficacy of an intranasal steroid delivered with a novel device. A post hoc analysis of recently published results with intranasal administration using a novel bidirectional delivery device containing fluticasone propionate (Opt-FP) was performed in 109 patients with mild-to-moderate bilateral polyposis. Patients were allocated to subgroups based on summed polyp score at baseline (2, 3, or 4) and on their history of previous sinus surgery. A highly significant and progressive reduction in summed polyp size was observed for Opt-FP versus placebo in all three polyp size subgroups (p < 0.001). A greater relative reduction in polyp size (p < 0.05) and an increase in peak nasal inspiratory flow (p < 0.001) were observed for Opt-FP at 12 weeks in the 28 patients with a baseline summed score of 3 and 4 compared with the 27 with a summed score of 2. Nevertheless, in patients with small polyps at baseline, the polyps were completely resolved on both sides in 7 of 27 patients. Previous sinus surgery had no impact on efficacy. The highly significant progressive treatment effect of Opt-FP was observed regardless of baseline polyps score. Coupled with the complete removal of polyps in many patients with small polyps, this suggests that improved deposition to target sites achieved with the bidirectional delivery device may translate into true clinical benefits and reduced need for surgery.

Chemoprevention of colorectal cancer: systematic review and economic evaluation

Chemoprevention of colorectal cancer: systematic review and economic evaluation

Effects of Oat Beta‐Glucan and Exercise Training on Tumor Burden in APC‐Min Mice

Both oat beta‐glucan (OBG) and exercise training (EXT) can enhance macrophage function. We hypothesized that EXT and OBG would reduce intestinal polyp burden in APC‐Min mice by reducing macrophage‐mediated inflammation and that the combination of the two treatments would have an added beneficial effect. Eighty male APC‐Min mice were randomly assigned to the following treatment groups at 4 wks of age: EXT, OBG, EXT and OBG, and control (CON). EXT mice ran on a treadmill (18–22 m/min, 60 min/d, 6 d/wk, 11 wks). OBG mice received 6 mg/ml of the soluble fiber in their drinking water daily. At 15 wks of age, mice were sacrificed and tissues collected. Polyps were counted based on size, crypt‐to‐villi (CV) ratios were measured, and macrophages in polyps and lamina propria were determined immunohistochemically. Statistical analysis was done using ANOVA and Tukey post‐hoc analysis. Compared with CON, there was a significant reduction in polyp size, polyp number, CV ratios, and macrophage numbers in the EXT and OBG groups. However, the combination of EXT and OBG resulted in a significant increase in deaths, polyp size, polyp number, and CV ratios compared with CON. Therefore, both OBG and EXT were beneficial in this mouse model, in part, through reduced macrophage tumor infiltration and inflammation. However, their combination was detrimental through an as‐yet‐undetermined mechanism.

Short course of systemic corticosteroids in sinonasal polyposis: A double-blind, randomized, placebo-controlled trial with evaluation of outcome measures

Topical and systemic corticosteroids are the first choice in medical treatments for sinonasal polyposis, but surprisingly, there is no high-level evidence for the efficacy of oral corticosteroids. The aim of this study was to establish the efficacy of a short course of oral prednisolone in ameliorating the symptoms of sinonasal polyposis, as well as reducing mucosal inflammation assessed by means of nasendoscopy and magnetic resonance imaging (MRI). A secondary aim was to evaluate the relationship between outcome measures. Subjects with symptomatic endoscopically diagnosed sinonasal polyposis received 50 mg of prednisolone daily for 14 days or placebo. Outcome was quantified by using the modified 31-item Rhinosinusitis Outcome Measure questionnaire, physician's assessment, nasendoscopy with photography, and MRI. There were 20 subjects in each treatment group. Only the prednisolone-treated group showed significant improvement in nasal symptoms (P < .001). The Rhinosinusitis Outcome Measure score improved in both groups, but the prednisolone-treated group had significantly greater improvement than the placebo group (P < .001). Objectively, there was significant reduction in polyp size, as noted with nasendoscopy (P < .001) and MRI (P < .001), only in the prednisolone-treated group. The outcome measures correlated with each other; the highest level of correlation was between the objective measures of nasendoscopy and MRI (R(2) = 0.76, P < .001). There were no significant adverse events. This trial clearly establishes clinically significant improvement in the symptoms and pathology of sinonasal polyposis with a short course of systemic corticosteroids. MRI scanning and quantitative nasendoscopic photography are objective and valid tools for assessing the outcome of treatment in this condition. A 14-day course of 50 mg of prednisolone is safe and effective therapy for symptomatic nasal polyposis.