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Review article: The incidence and prevalence of colorectal cancer in inflammatory bowel disease

Department of Medical Gastroenterology, Hvidovre University Hospital, Copenhagen, Denmark.
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.48). 10/2003; 18 Suppl 2(s2):1-5. DOI: 10.1046/j.1365-2036.18.s2.2.x
Source: PubMed

ABSTRACT Although colorectal cancer (CRC), complicating ulcerative colitis and Crohn's disease, only accounts for 1-2% of all cases of CRC in the general population, it is considered a serious complication of the disease and accounts for approximately 15% of all deaths in inflammatory bowel disease (IBD) patients. The magnitude of the risk was found to differ, even in population-based studies. Recent figures suggest that the risk of colon cancer for people with IBD increases by 0.5-1.0% yearly, 8-10 years after diagnosis. The magnitude of CRC risk increases with early age at IBD diagnosis, longer duration of symptoms, and extent of the disease, with pancolitis having a more severe inflammation burden and risk of the dysplasia-carcinoma cascade. Considering the chronic nature of the disease, it is remarkable that there is such a low incidence of CRC in some of the population-based studies, and possible explanations have to be investigated. One possible cancer-protective factor could be treatment with 5-aminosalicylic acid preparations (5-ASAs). Adenocarcinoma of the small bowel is extremely rare, compared with adenocarcinoma of the large bowel. Although only few small bowel cancers have been reported in Crohn's disease, the number was significantly increased in relation to the expected number.

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    • "The incidence of chronic intestinal diseases such as ulcerative colitis and Chron's disease is continually increasing in different regions of the world (Latella and Papi, 2012) and the complications can account for almost 15% of all deaths (Munkholm, 2003). 5-Aminosalicylic acid (5ASA) is an anti-inflammatory drug used in the treatment of intestinal diseases, which has been considered as a potential chemopreventive agent (Velayos et al., 2005). "
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    ABSTRACT: This work introduces results on a new drug delivery system (DDS) based on the use of chitosan/layered double hydroxide (LDH) biohybrid beads coated with pectin for controlled release in the treatment of colon diseases. Thus, the 5-aminosalicylic acid (5ASA), the most used non-steroid-anti-inflammatory drug (NSAID) in the treatment of ulcerative colitis and Crohn's disease, was chosen as model drug aiming to a controlled and selective delivery in the colon. The pure 5ASA drug and the hybrid material prepared by intercalation in a layered double hydroxide of Mg2Al using the co-precipitation method, were incorporated in a chitosan matrix in order to profit from its mucoadhesiveness. These compounds processed as beads were further treated with the polysaccharide pectin to create a protective coating that ensures the stability of both chitosan and layered double hydroxide at the acid pH of the gastric fluid. The resulting composite beads presenting the pectin coating are stable to water swelling and procure a controlled release of the drug along their passage through the simulated gastrointestinal tract in in vitro experiments, due to their resistance to pH changes. Based on these results, the pectin@chitosan/LDH-5ASA bionanocomposite beads could be proposed as promising candidates for the colon-targeted delivery of 5ASA, with the aim of acting only in the focus of the disease and minimizing side effects.
    International Journal of Pharmaceutics 12/2013; 463(1). DOI:10.1016/j.ijpharm.2013.12.035
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    • "Inflammation has been widely known as strong risk and promoting factor of carcinogenesis (Balkwill and Mantovani, 2001) in various types of human cancers (Ohshima et al., 2003). Among them, ulcerative colitis is in high risk condition in colonic carcinogensis (Munkholm, 2003). In the animal counterpart, dextran sulfate sodium (DSS) (Okayasu et al., 1990) showed powerful tumor promoting effect in murine colonic carcinogenesis models initiated with azoxymethane (AOM) (Tanaka et al., 2003), 1,2-dimethylhydrazine (DMH) (Kohno et al., 2005), and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) (Tanaka et al., 2005). "
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    ABSTRACT: Inflammation is potential risk factor of various human malignancies. Inflammatory bowel syndromes such as ulcerative colitis are well known as risk factors for colon cancer. Here, we examined enhancing effects of dextran sulfate sodium (DSS)-associated inflammation on X-irradiation induced colonic tumorigenesis in Min and wild-type (WT) mice. Animals were X-irradiated at 1.5 Gy at 5 weeks of age (at 0 experimental week) and 2% DSS in drinking water was administered at 5 or 11 experimental weeks. Mice were sacrificed at 16 weeks and incidence and multiplicity of colonic tumors were assessed. Incidence of colonic tumors in Min mouse was increased from 33.3% to 100% (p<0.05) with X-irradiation alone, whereas no tumors were developed in WT mice. In DSS-treated Min mice, X-irradiation increased the number of colonic tumors. Total number of colonic tumors was increased 1.57 times to 30.7±3.83 tumors/mouse with X-irradiation+DSS at 5 weeks comapared to 19.6±2.9 in corresponding DSS alone group (p<0.05). When the duration of inflammation was compared, longer period of DSS effect promoted more colonic tumorigenesis. Collectively, we conclude that X-irradiation and DSS-induced inflammation act synergistically for colonic tumorigenesis.
    Asian Pacific journal of cancer prevention: APJCP 07/2013; 14(7):4135-9. DOI:10.7314/APJCP.2013.14.7.4135
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    • "Adenomatous polyps and cancers located in the distal and proximal colon were considered separately to account for the reach of FSIG, with some correlation implicitly modelled by assuming 70% arose in the distal, and 30% in the proximal, colon. Fourteen percent of cancers (based on Munkholm, 2003; Makinen, 2007) were assumed to develop without a prior adenoma (i.e. in individuals with inflammatory bowel disease, or flat or serrated adenomas) and modelled as direct progression from normal epithelium to stage I cancer. The screening intervention model was superimposed upon the natural history model. "
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    ABSTRACT: Several colorectal cancer-screening tests are available, but it is uncertain which provides the best balance of risks and benefits within a screening programme. We evaluated cost-effectiveness of a population-based screening programme in Ireland based on (i) biennial guaiac-based faecal occult blood testing (gFOBT) at ages 55-74, with reflex faecal immunochemical testing (FIT); (ii) biennial FIT at ages 55-74; and (iii) once-only flexible sigmoidoscopy (FSIG) at age 60. A state-transition model was used to estimate costs and outcomes for each screening scenario vs no screening. A third party payer perspective was adopted. Probabilistic sensitivity analyses were undertaken. All scenarios would be considered highly cost-effective compared with no screening. The lowest incremental cost-effectiveness ratio (ICER vs no screening euro 589 per quality-adjusted life-year (QALY) gained) was found for FSIG, followed by FIT euro 1696) and gFOBT (euro 4428); gFOBT was dominated. Compared with FSIG, FIT was associated with greater gains in QALYs and reductions in lifetime cancer incidence and mortality, but was more costly, required considerably more colonoscopies and resulted in more complications. Results were robust to variations in parameter estimates. Population-based screening based on FIT is expected to result in greater health gains than a policy of gFOBT (with reflex FIT) or once-only FSIG, but would require significantly more colonoscopy resources and result in more individuals experiencing adverse effects. Weighing these advantages and disadvantages presents a considerable challenge to policy makers.
    British Journal of Cancer 02/2012; 106(5):805-16. DOI:10.1038/bjc.2011.580
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