Chemoprevention of colorectal cancer in ulcerative colitis: digging deep in current evidence. (3rd April 2017)

• Record Type: Journal Article
• Authors: Bezzio, Cristina; Festa, Stefano; Saibeni, Simone; Papi, Claudio
• Is Part Of: Expert review of gastroenterology & hepatology. Volume 11:Number 4(2017)
• Page Start: 339
• Page End: 347
• Publication Date: 2017-04-03
• Subjects: Colorectal cancer -- ulcerative colitis -- chemoprevention -- mesalazine -- thiopurines -- anti-TNF alpha -- ursodeoxycholic acid -- folic acid -- statins; Gastroenterology -- Periodicals; Liver -- Diseases -- Periodicals; 616.3
• DOI: 10.1080/17474124.2017.1292129
• Languages: English
• ISSNs: 1747-4124

Abstract

ABSTRACT: Introduction: Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). Surveillance colonoscopy is currently recommended for patients with long-standing extensive colitis for reducing CRC risk. Chemoprevention is an attractive complementary strategy. Areas covered: Inflammation is a major determinant of CRC risk and is potentially modifiable. Reducing inflammation is supposed to reduce CRC risk. Several medications have been evaluated in this setting: 5-ASA, thiopurines, anti-TNFα agents and ursodeoxycholic acid (UCDA) in patients with associated primary sclerosing cholangitis (PSC). This review offers a critical evaluation of current evidence of the potential chemopreventive effect of such medications. Expert commentary: No randomized controlled trials have been performed and the available evidence come from observational studies. Although biological plausibility supports a chemopreventive role of the aforementioned agents, the overall evidence of efficacy is weak because of several methodological limitations of the studies. Indirect epidemiological evidence, biologic plausibility and results of meta-analyses reasonably support a potential chemopreventive effect of 5-ASA. Available evidence does not support a specific chemopreventive effect of purine analogues and anti-TNFα medications, despite their efficacy in the management of inflammatory bowel disease. Data addressing UDCA and folate supplementation are inconclusive. Limited data are available for statins.