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Dr. Roger Haggitt
Gastroenterology News continued
Death Knell for Barium Enema as a Diagnostic? hether double-contrast barium enema or colonoscopy is the preferred option for surveillance of patients who have undergone colonoscopic polypectomy has been the source of controversy and some contention between gastroenterologists and radiologists. That controversy will likely be put to rest after publication in the June 15, 2000, New England Journal of Medicine of a large multicenter study by Winawer et al. comparing the ability of the two procedures to diagnose polyps in this high-risk patient group. It was a rout. Barium enema detected abnormalities in only one third of patients who were found to have adenomas by
W
Toxic Gas May Have a Therapeutic Future ould a toxic compound turn out to be a therapeutic for inflammatory bowel disease? In the April 2000 issue of Nature Medicine, Otterbein et al. reported their finding that carbon monoxide, a result of the catabolism of heme by heme oxygenase, produced potent anti-inflammatory effects. The pathway to the anti-inflammatory effects of CO was unrelated to that of its toxic effects; whereas carbon monox-
C
colonoscopy. Barium enema found only about half of the larger adenomas (⬎1.0 cm), and only about one fifth of the smaller ones (0.5 cm or less) detected by colonoscopy. “This provides evidence for what we believed, which is that barium enema is not a very accurate test in detecting polyps of various sizes. . .even the larger ones,” said the article’s lead author, Sidney Winawer, M.D., of Memorial Sloan-Kettering Cancer Center. Winawer believes the study’s design—a prospective, multicenter study planned by radiologists and endoscopists with equivalent expertise—makes it difficult to dispute. Robert H. Fletcher, M.D., of Harvard Medical School, who wrote an editorial accompanying the article, suspects
there will still be a place for barium enema as a screening tool, where expectations of accuracy are lower. “I wouldn’t think it’s necessarily the end of barium enema for screening, although it’s possible people will vote with their feet and walk away from it,” he said. “Logically, though, if it’s missing half of the large polyps, so does sigmoidoscopy, for example, since it examines only half the colon.” That issue, notwithstanding, Fletcher believes that the study provides strong evidence that except in cases in which colonoscopy cannot provide an examination of the full colon, barium enema probably has little place as a diagnostic test for patients at high risk for adenomatous polyps.
ide poisoning involves an irreversible binding to hemoglobin, the anti-inflammatory effects are mediated through a pathway in which mitogen-activated protein kinases are stimulated. “This is surprising,” said J. Thomas LaMont, M.D., of Beth Israel Deaconess Medical Center and Harvard Medical School. “We usually think of carbon monoxide as a toxic gas to be completely avoided, but these data suggest that if we could control its delivery to humans, we might be able to accomplish some good.”
Particularly intriguing to gastroenterologists would be a potential use for low levels of carbon monoxide in treating inflammatory bowel disease. LaMont believes the next step should be in vivo studies in animal models of inflammatory bowel disease. “The question is whether there is a compound like carbon monoxide that would be completely harmless,” he said. “If we could better understand how carbon monoxide works, we could possibly come up with a compound that mimics its effect but has none of the toxic side effects.”
associated changes in the colon and the characterization of Barrett’s esophagus. Among his many accomplishments and responsibilities, Dr. Haggitt was a former member of the editorial board of this journal and made many contributions as investigator, practicing pathologist, and teacher.
Dr. Roger Haggitt r. Roger Haggitt, preeminent GI pathologist, was shot and killed on June 29, 2000, by a pathology resident dismissed for poor performance. Dr. Haggitt, Professor of Pathology at the University of Washington, was especially known for his many contributions to the study of dysplasia including rigorous criteria for ulcerative colitis–
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Stories by Dan Gordon Daniel K. Podolsky Editor Dr. Roger Haggitt
612
Death Knell for Barium Enema as a Diagnostic? hether double-contrast barium enema or colonoscopy is the preferred option for surveillance of patients who have undergone colonoscopic polypectomy has been the source of controversy and some contention between gastroenterologists and radiologists. That controversy will likely be put to rest after publication in the June 15, 2000, New England Journal of Medicine of a large multicenter study by Winawer et al. comparing the ability of the two procedures to diagnose polyps in this high-risk patient group. It was a rout. Barium enema detected abnormalities in only one third of patients who were found to have adenomas by
W
Toxic Gas May Have a Therapeutic Future ould a toxic compound turn out to be a therapeutic for inflammatory bowel disease? In the April 2000 issue of Nature Medicine, Otterbein et al. reported their finding that carbon monoxide, a result of the catabolism of heme by heme oxygenase, produced potent anti-inflammatory effects. The pathway to the anti-inflammatory effects of CO was unrelated to that of its toxic effects; whereas carbon monox-
C
colonoscopy. Barium enema found only about half of the larger adenomas (⬎1.0 cm), and only about one fifth of the smaller ones (0.5 cm or less) detected by colonoscopy. “This provides evidence for what we believed, which is that barium enema is not a very accurate test in detecting polyps of various sizes. . .even the larger ones,” said the article’s lead author, Sidney Winawer, M.D., of Memorial Sloan-Kettering Cancer Center. Winawer believes the study’s design—a prospective, multicenter study planned by radiologists and endoscopists with equivalent expertise—makes it difficult to dispute. Robert H. Fletcher, M.D., of Harvard Medical School, who wrote an editorial accompanying the article, suspects
there will still be a place for barium enema as a screening tool, where expectations of accuracy are lower. “I wouldn’t think it’s necessarily the end of barium enema for screening, although it’s possible people will vote with their feet and walk away from it,” he said. “Logically, though, if it’s missing half of the large polyps, so does sigmoidoscopy, for example, since it examines only half the colon.” That issue, notwithstanding, Fletcher believes that the study provides strong evidence that except in cases in which colonoscopy cannot provide an examination of the full colon, barium enema probably has little place as a diagnostic test for patients at high risk for adenomatous polyps.
ide poisoning involves an irreversible binding to hemoglobin, the anti-inflammatory effects are mediated through a pathway in which mitogen-activated protein kinases are stimulated. “This is surprising,” said J. Thomas LaMont, M.D., of Beth Israel Deaconess Medical Center and Harvard Medical School. “We usually think of carbon monoxide as a toxic gas to be completely avoided, but these data suggest that if we could control its delivery to humans, we might be able to accomplish some good.”
Particularly intriguing to gastroenterologists would be a potential use for low levels of carbon monoxide in treating inflammatory bowel disease. LaMont believes the next step should be in vivo studies in animal models of inflammatory bowel disease. “The question is whether there is a compound like carbon monoxide that would be completely harmless,” he said. “If we could better understand how carbon monoxide works, we could possibly come up with a compound that mimics its effect but has none of the toxic side effects.”
associated changes in the colon and the characterization of Barrett’s esophagus. Among his many accomplishments and responsibilities, Dr. Haggitt was a former member of the editorial board of this journal and made many contributions as investigator, practicing pathologist, and teacher.
Dr. Roger Haggitt r. Roger Haggitt, preeminent GI pathologist, was shot and killed on June 29, 2000, by a pathology resident dismissed for poor performance. Dr. Haggitt, Professor of Pathology at the University of Washington, was especially known for his many contributions to the study of dysplasia including rigorous criteria for ulcerative colitis–
D
Stories by Dan Gordon Daniel K. Podolsky Editor Dr. Roger Haggitt
612