- Email: [email protected]
Chemoprevention against colorectal cancer and NSAID use in minority population
S162
Abstracts
AJG – Vol. 96, No. 9, Suppl., 2001
obstructing sigmoid masses. Other findings included adenomas (13%) and 1 malignant polyp.
Findings cancer malignant polylp adenoma stricture other (including normal, hemorrhoids or diverticula)
CONSTIP (n ⴝ 108) n (%)
CONSTIPⴙ (n ⴝ 185) n (%)
0 (0) 1 (0.9) 16 (15) 3 (2.8) 88 (81)
3 (1.6) 0 (0) 21 (11) 2 (1.1) 159 (86)
P 0.18 0.19 0.39 0.28
117/8535 (1.4%) LE had findings of previously undiagnosed cancer (59/117, 50%) or benign mass or stricture, including the 3/59 (5%) cancer cases with CONSTIP⫹. The leading LE indications in cancer cases were bleeding or anemia (61%). Conclusions: Lower endoscopy for constipation is unlikely to reveal obstructing cancer, but this diagnosis must be considered in constipated patients with additional symptoms. Although adenomas do not explain constipation, their detection is a benefit of lower endoscopy in this population.
508 Does polyp histology at flexible sigmoidoscopy predict findings in the proximal colon? Waqar A Qureshi, M.D., FACG*, Mary Heiser, R.N., M.S., Rhonda A Cole, M.D. and B S Anand, M.D., FACG. 1Medicine, VA Medical Center, Houston, TX, United States; and 2Baylor College of Medicine, Houston, TX, United States. Purpose: Flexible sigmoidoscopy (FS) is currently the primary tool for the screening of colon cancer. It is generally agreed that colonoscopy should be performed on patients who show adenomatous polyps on FS. However, the approach to patients with hyperplastic polyps is unclear. In the present study, the colonoscopic findings in patients with hyperplastic polyps on screening FS was compared with that in patients with adenomatous polyps. Methods: All patients referred to the colon cancer screening clinic who were found to have one or more polyps at FS were invited to undergo a complete colonoscopy. The findings at colonoscopy as well as the histology of any lesions identified were recorded. The persons performing the colonoscopic examination were unaware of the findings at FS. Results: A positive lesion on FS was found in 434 patients comprising of 299 (69%) patients with adenomatous polyps, 93 (21%) with hyperplastic polyps and 42 (10%) with carcinoma. Patients with cancer were significantly older (68.7 ⫾ 8 y) than those with adenomatous polyps (65.3 ⫾ 8.7 y; p ⫽ 0.01) or hyperplastic polyps (63.5 ⫾ 8.8 y; p ⫽ 0.002). Patients with adenomatous polyps on FS had higher prevalence of proximal adenomas (106; 35.5%) compared to those with hyperplastic polyps on FS (20; 21.5%) (⫻2 ⫽ 6.32; p ⬍ 0.02). Similar findings were observed in patients who had cancer on FS; the prevalence of proximal adenomas (16; 38%) was significantly greater than that in patients with hyperplastic polyps significant (X2 ⫽ 4.07; p ⬍ 0.05) and was equal to that in patients with adenomatous polyps. The prevalence of proximal cancer was similar in patients with distal adenomatous polyps compared to hyperplastic polyps (1% vs. 2%). Conclusions: Patients with distal adenoma or cancer have a higher prevalence of proximal adenomas compared to those with distal hyperplastic polyps. However, the finding that ⬎20% patients with hyperplastic polyps on FS had proximal adenomas and 2% had cancer suggests that distal hyperplastic polyps may represent an abnormal colonic mucosa. Full colonoscopy should be performed on all patients with distal polyps, irrespective of the polyp histology.
509 Chemoprevention against colorectal cancer and NSAID use in minority population Gopal A Ramaraju1, Adedayo O Mokuolu1, Olusola Olofinlade1 and Samuel J Daniel1*. 1Medicine, North General Hospital, New York, New York, United States. Purpose: The third leading cause of cancer death in the United States is colorectal cancer. Animal studies have shown aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) as chemo preventive agents in carcinogen induced colorectal tumors. In human studies, there is evidence that exposure to NSAIDS leads to decrease in colorectal tumors. However, none of these studies have investigated the role of NSAIDS in African American and Latino population with colorectal tumors. The purpose of this study is to investigate the role of non-steroidal anti-inflammatory agents in African American and Latino populations with colorectal tumors. Methods: This was a retrospective case control study of patients that had colonoscopy at North General Hospital over a two year period between January 1998 and December 1999. NSAID use in patients with colorectal tumors was compared to age and sex matched controls without tumors. Results: 745 colonoscopies were done during this period. 129 patients (17.3%) had colorectal tumors. 29 of these patients had colorectal cancer and 100 patients had adenomatous polyps. The average age of patients with colorectal tumors was 67.5 years and 54% were female. The control group for this study were 112 age and sex matched controls with no colorectal tumors on colonoscopy. 36 patients (27.%) with colorectal tumors compared to 42 patients (57.7%) without tumors were on NSAIDS, (Odds Ratio(O.R.) ⫽ 1.55; 95% Confidence Intervals(CI) 0.90 –2.66). 32 patients (32%) with adenomatous polyps were on NSAIDS, (O.R. ⫽ 0.78; 95% CI 0.44 –1.38). 4 patients (13.7%) with colorectal cancer compared to 57.7% without colorectal cancer were on NSAIDS, (O.R. ⫽ 0.27; 95% CI 0.09 – 0.82). The exposure to NSAIDS was therefore associated with reduced prevalence of colorectal tumors although this was only statistically significant in patients with colorectal cancer and not in those with adenomatous polyps. Conclusions: This study suggests that the use of NSAIDS might have a primary preventive role in colorectal cancer in minority population.
510 CMV colitis in immunocompetent patients: a report of 2 cases and review of the literature Susan Ramdhaney, M.D.; Tim Hinedi, M.D.; Jane Vlodov, M.D.; Seth Lapin, D.O.; Christine Huh, D.O.; Rose Mary Jose, M.D.; Kadirawel Iswara, M.D. F.A.C.G.; Scott Tenner, M.D., M.P.H. Maimonides Medical Center, State University of New York Health Sciences Center, Brooklyn, New York. Cytomegalovirus (CMV) colitis in immunocompromised patients is well known. However, CMV colitis in immunocompetent individuals is a rarity. There have been only 19 reported cases to date. We describe 2 cases and reviewed the literature. Case 1: 79yo female PMHx CAD and RA was admitted with dehydration due to a 1-week history of watery diarrhea and hematochezia. Stool studies were negative. The patient underwent a colonoscopy which revealed shallow ulcerations in the sigmoid colon. Bx revealed enlarged endothelial cells with inclusion bodies c/w CMV colitis. Case 2:77yo female PMHx Alzheimer’s disease presented with hematochezia and rectal pain. On rectal exam the patient was found to have a large rectal mass at the anal verge which was also visualized on colonoscopy. Bx revealed inclusion bodies c/w CMV colitis. Neither patients were immunocompromised; both were HIV negative, and had no h/o steroid use or DM. Both patients were treated with IV ganciclovir for 8 weeks with complete resolution of symptoms. Conclusion: Although CMV esophagitis is commonly seen in immunocompetent elderly patients, CMV colitis is a rarity. A MEDLINE search
Abstracts
AJG – Vol. 96, No. 9, Suppl., 2001
obstructing sigmoid masses. Other findings included adenomas (13%) and 1 malignant polyp.
Findings cancer malignant polylp adenoma stricture other (including normal, hemorrhoids or diverticula)
CONSTIP (n ⴝ 108) n (%)
CONSTIPⴙ (n ⴝ 185) n (%)
0 (0) 1 (0.9) 16 (15) 3 (2.8) 88 (81)
3 (1.6) 0 (0) 21 (11) 2 (1.1) 159 (86)
P 0.18 0.19 0.39 0.28
117/8535 (1.4%) LE had findings of previously undiagnosed cancer (59/117, 50%) or benign mass or stricture, including the 3/59 (5%) cancer cases with CONSTIP⫹. The leading LE indications in cancer cases were bleeding or anemia (61%). Conclusions: Lower endoscopy for constipation is unlikely to reveal obstructing cancer, but this diagnosis must be considered in constipated patients with additional symptoms. Although adenomas do not explain constipation, their detection is a benefit of lower endoscopy in this population.
508 Does polyp histology at flexible sigmoidoscopy predict findings in the proximal colon? Waqar A Qureshi, M.D., FACG*, Mary Heiser, R.N., M.S., Rhonda A Cole, M.D. and B S Anand, M.D., FACG. 1Medicine, VA Medical Center, Houston, TX, United States; and 2Baylor College of Medicine, Houston, TX, United States. Purpose: Flexible sigmoidoscopy (FS) is currently the primary tool for the screening of colon cancer. It is generally agreed that colonoscopy should be performed on patients who show adenomatous polyps on FS. However, the approach to patients with hyperplastic polyps is unclear. In the present study, the colonoscopic findings in patients with hyperplastic polyps on screening FS was compared with that in patients with adenomatous polyps. Methods: All patients referred to the colon cancer screening clinic who were found to have one or more polyps at FS were invited to undergo a complete colonoscopy. The findings at colonoscopy as well as the histology of any lesions identified were recorded. The persons performing the colonoscopic examination were unaware of the findings at FS. Results: A positive lesion on FS was found in 434 patients comprising of 299 (69%) patients with adenomatous polyps, 93 (21%) with hyperplastic polyps and 42 (10%) with carcinoma. Patients with cancer were significantly older (68.7 ⫾ 8 y) than those with adenomatous polyps (65.3 ⫾ 8.7 y; p ⫽ 0.01) or hyperplastic polyps (63.5 ⫾ 8.8 y; p ⫽ 0.002). Patients with adenomatous polyps on FS had higher prevalence of proximal adenomas (106; 35.5%) compared to those with hyperplastic polyps on FS (20; 21.5%) (⫻2 ⫽ 6.32; p ⬍ 0.02). Similar findings were observed in patients who had cancer on FS; the prevalence of proximal adenomas (16; 38%) was significantly greater than that in patients with hyperplastic polyps significant (X2 ⫽ 4.07; p ⬍ 0.05) and was equal to that in patients with adenomatous polyps. The prevalence of proximal cancer was similar in patients with distal adenomatous polyps compared to hyperplastic polyps (1% vs. 2%). Conclusions: Patients with distal adenoma or cancer have a higher prevalence of proximal adenomas compared to those with distal hyperplastic polyps. However, the finding that ⬎20% patients with hyperplastic polyps on FS had proximal adenomas and 2% had cancer suggests that distal hyperplastic polyps may represent an abnormal colonic mucosa. Full colonoscopy should be performed on all patients with distal polyps, irrespective of the polyp histology.
509 Chemoprevention against colorectal cancer and NSAID use in minority population Gopal A Ramaraju1, Adedayo O Mokuolu1, Olusola Olofinlade1 and Samuel J Daniel1*. 1Medicine, North General Hospital, New York, New York, United States. Purpose: The third leading cause of cancer death in the United States is colorectal cancer. Animal studies have shown aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) as chemo preventive agents in carcinogen induced colorectal tumors. In human studies, there is evidence that exposure to NSAIDS leads to decrease in colorectal tumors. However, none of these studies have investigated the role of NSAIDS in African American and Latino population with colorectal tumors. The purpose of this study is to investigate the role of non-steroidal anti-inflammatory agents in African American and Latino populations with colorectal tumors. Methods: This was a retrospective case control study of patients that had colonoscopy at North General Hospital over a two year period between January 1998 and December 1999. NSAID use in patients with colorectal tumors was compared to age and sex matched controls without tumors. Results: 745 colonoscopies were done during this period. 129 patients (17.3%) had colorectal tumors. 29 of these patients had colorectal cancer and 100 patients had adenomatous polyps. The average age of patients with colorectal tumors was 67.5 years and 54% were female. The control group for this study were 112 age and sex matched controls with no colorectal tumors on colonoscopy. 36 patients (27.%) with colorectal tumors compared to 42 patients (57.7%) without tumors were on NSAIDS, (Odds Ratio(O.R.) ⫽ 1.55; 95% Confidence Intervals(CI) 0.90 –2.66). 32 patients (32%) with adenomatous polyps were on NSAIDS, (O.R. ⫽ 0.78; 95% CI 0.44 –1.38). 4 patients (13.7%) with colorectal cancer compared to 57.7% without colorectal cancer were on NSAIDS, (O.R. ⫽ 0.27; 95% CI 0.09 – 0.82). The exposure to NSAIDS was therefore associated with reduced prevalence of colorectal tumors although this was only statistically significant in patients with colorectal cancer and not in those with adenomatous polyps. Conclusions: This study suggests that the use of NSAIDS might have a primary preventive role in colorectal cancer in minority population.
510 CMV colitis in immunocompetent patients: a report of 2 cases and review of the literature Susan Ramdhaney, M.D.; Tim Hinedi, M.D.; Jane Vlodov, M.D.; Seth Lapin, D.O.; Christine Huh, D.O.; Rose Mary Jose, M.D.; Kadirawel Iswara, M.D. F.A.C.G.; Scott Tenner, M.D., M.P.H. Maimonides Medical Center, State University of New York Health Sciences Center, Brooklyn, New York. Cytomegalovirus (CMV) colitis in immunocompromised patients is well known. However, CMV colitis in immunocompetent individuals is a rarity. There have been only 19 reported cases to date. We describe 2 cases and reviewed the literature. Case 1: 79yo female PMHx CAD and RA was admitted with dehydration due to a 1-week history of watery diarrhea and hematochezia. Stool studies were negative. The patient underwent a colonoscopy which revealed shallow ulcerations in the sigmoid colon. Bx revealed enlarged endothelial cells with inclusion bodies c/w CMV colitis. Case 2:77yo female PMHx Alzheimer’s disease presented with hematochezia and rectal pain. On rectal exam the patient was found to have a large rectal mass at the anal verge which was also visualized on colonoscopy. Bx revealed inclusion bodies c/w CMV colitis. Neither patients were immunocompromised; both were HIV negative, and had no h/o steroid use or DM. Both patients were treated with IV ganciclovir for 8 weeks with complete resolution of symptoms. Conclusion: Although CMV esophagitis is commonly seen in immunocompetent elderly patients, CMV colitis is a rarity. A MEDLINE search