Intestinal Polypoid Adenomas Medication

  • Author: Alan BR Thomson, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 5, 2012
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

Growing evidence suggests a protective role for NSAIDs against the development of colorectal cancer. In addition, a significant effect in reversing adenoma growth has been illustrated with the use of sulindac and celecoxib in patients with FAP. Aspirin may also be useful to reduce the recurrence of polyps or cancer, but because of the potential for these drugs to cause damage to the upper gastrointestinal tract, they are not routinely recommended for this purpose. The mechanism of NSAID-induced polyp regression is not known, but it may involve the selective induction of apoptotic cell death in the adenomatous mucosa.

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Sulindac (Clinoril)

 

Sulindac is a sulfoxide, which is metabolized to the anti-inflammatory sulfide metabolite and a sulfone metabolite. Both metabolites are known to have apoptotic activity on colonic epithelial cells, but whether this is required for the chemoregressive activity of these drugs is not known. Multiple systemic effects, including analgesia, antipyretic, and anti-inflammatory, mostly mediated by inhibition of prostaglandin synthesis.

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Celecoxib (Celebrex)

 

Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Multiple systemic effects, including analgesia, antipyretic, and anti-inflammatory, mostly mediated by selective inhibition of prostaglandin synthesis.

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Contributor Information and Disclosures
Author

Alan BR Thomson, MD  Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Dennis J Ahnen, MD  Staff Physician, Denver VA Medical Center and Professor of Medicine, University of Colorado Denver School of Medicine

Dennis J Ahnen, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Gastroenterological Association, Crohns and Colitis Foundation of America, and Gastroenterology Research Group

Disclosure: EXACT Sciences travel expenses Review panel membership

Specialty Editor Board

Rajeev Vasudeva, MD, FACG  Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Columbia Medical Society, South Carolina Gastroenterology Association, and South Carolina Medical Association

Disclosure: Pricara Honoraria Speaking and teaching; UCB Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, John Riopelle, DO, to the development and writing of this article.

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Intestinal polypoid adenomas. Endoscopic view of pedunculated polyp.
Intestinal polypoid adenomas. Endoscopic view of sessile polyp.
Intestinal polypoid adenomas. Tubular adenoma, low-power view. Courtesy of G. Warren, MD, Rose Medical Center, Denver, Colo.
Intestinal polypoid adenomas. Villous adenoma, low-power view. Courtesy of G. Warren, MD, Rose Medical Center, Denver, Colo.
Intestinal polypoid adenomas. High-power view of adenomatous polyp with low-grade dysplasia. Courtesy of G. Warren, MD, Rose Medical Center, Denver, Colo.
Intestinal polypoid adenomas. Villous adenoma with grade IV invasive carcinoma. Courtesy of G. Warren, Rose Medical Center, Denver, Colo.
 
 
 
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