Digestive Health Watch

Colonoscopy Screening Shows Advantages Past Age 75 Years

Ann G. Zauber, MD, a biostatistician from Memorial SloanKettering Cancer Center in New York City, presented a simulated model at Digestive Disease Week 2011 in Chicago, Illinois, that demonstrated the benefits of screening for colorectal cancer in patients over the age of 75 years who have never been screened before. Previously, the recommendation from the US Preventive Services Task Force was to begin screening for colorectal cancer at the age of 50 years and continue until age 75 years.

Dr. Zauber and colleagues, however, have shown that the amount of life-years gained if screening occurs after age 75 years, though substantially less, is not insignificant. Even without including the cost of biologics in the treatment of colorectal cancer, the study shows that screening older patients, and thus treating early and noninvasive disease, is cost effective. The results of the study demonstrate that while the benefit of screening may extend beyond the age of 75 years to the age of 85 years, the biggest benefit is seen when patients begin colonoscopy screening at the age of 50 years.

Because the average age of diagnosis of colorectal cancer is 71 years, the researchers point out, the importance of screening in older patients cannot be overstated. Colorectal cancer is the second leading cause of cancer-related death in the United States. PT

Asymptomatic Celiac Disease Improves from Early Intervention

In a poster presented in Chicago, Illinois, in May for Digestive Disease Week 2011, researchers from Finland have shown that in patients who are at high risk for celiac disease but are asymptomatic, serologic screening and initiation of early gluten-free diets can promote mucosal healing.

The study identified 3031 relatives of celiac disease patients, 148 of whom tested positive through serologic screening for an antibody implicated in celiac disease. Forty of these patients were then equally randomized to begin a gluten-free diet or continue their usual diet. They were then evaluated 1 year later, at which point 18 of the 20 control patients decided to begin the gluten-free diet as well. The researchers found that after 1 year, the patients who had begun the gluten-free diet had significantly fewer mucosal lesions, defined as the change in the ratio of villous height/crypt depth from baseline, decreased titers in serologic antibody, and improved quality of life compared with the control group (all P values <.001).

The study, although subjective and not blinded, shows that early gluten-free diets in patients who show no symptoms of but are at high risk for celiac disease can have immense benefits in promoting intestinal health and overall quality of life. Longer follow-up studies are needed to demonstrate prolonged benefit of the diet.

SSRIs May Be Beneficial in Some Patients with Reflux Disease

Researchers from Greece have found that a certain subset of patients with esophageal reflux disease who fail therapy with proton pump inhibitors (PPIs) may benefit from therapy with selective serotonin reuptake inhibitors (SSRIs).

The study, published in the May 31, 2011, issue of the American Journal of Gastroenterology, enrolled 252 patients with symptoms like heartburn, chest pain, and regurgitation but with normal endoscopy. This patient profile is consistent with a condition called nonerosive esophageal reflux disease, or NERD. All patients had failed an adequate trial of a PPI given twice daily, and were evaluated with 24-hour pH-impedance monitoring. Patients who were classified as having a hypersensitive esophagus, which is defined as having symptoms of reflux disease despite a normal distal esophageal acid exposure time, were randomized to receive either citalopram 20 mg or placebo once daily.

After 6 months of treatment, the researchers found that patients who received citalopram reported significantly fewer symptoms of reflux disease than the patients who received placebo (38.5% vs 66.7%, P = .021). The results, the authors point out, demonstrate that in patients who fail PPI therapy, alternative therapies must be considered, and SSRIs may be one option.