Magnetic Resonance colonography effective finding cancers and polyps larger than 5 mm

German researchers compared dark lumen magnetic resonance imaging to conventional optical colonoscopy in 92 patients referred for a non-screening colonoscopy.  After standard pre-colonoscopy colon cleansing, patients received MR imaging followed immediately by colonoscopy.

47% of patients had normal conventional colonoscopies with no polyps found.  For the other 53%, there were 107 polyps discovered:  82 adenomas, 25 hyperplastic polyps, and 7 carcinomas.  MR colonography found all of the adenomas over 10 millimeters in size and 84% of those 6 to 9 millimeters.  On a per patient basis, MR colonography was 93% accurate (89% sensitive in finding polyps, 96% specific in not identifying false positive results) when polyps of all sizes were considered.

Patients were prepared for the MR test by having their colons filled with approximately 2 liters of tap water, and IV contrast was used.

Dirk Hartmann M.D. and his colleagues reported the results of their study online before print in Radiology, November 22, 2005.  They concluded,

 Dark-lumen MR colonography is a promising modality with high accuracy for detecting colorectal polyps larger than 5 mm in diameter.

Use of CT colonoscopy (so-called virtual colonoscopy) is controversial in Europe where questions of radiation concern both patients and environmental groups.  During the 2005 RSNA several papers addressed the use of dark lumen magnetic resonance colonography as a non-invasive alternative to both optical colonoscopy and CT-colonography. 

Posted by Kate Murphy on December 27th, 2005
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Heartburn medications are risk factor for c. difficile infection

Heartburn medications that reduce stomach acidity may contribute to  Clostridium difficile infections that occur outside of hospitals. So-called community-acquired infections are much less common than those found in hospitals and appear to have a different pattern according to research in the December 21, 2005 issue of the Journal of the American Medical Association.

Researchers found that patients who were taking a proton pump inhibitor such as Nexium™, Prilosec™ or Protonix™ were three times more likely to have a C.difficile infection than study participants who were not.  H2–receptor antagonists including Tagamet™, Zantec™, and Pepcid™ doubled risk for C.difficile.  There was also a moderate increase in risk among patients taking NSAIDs — non-steroidal anti-inflammatory drugs.

Using a United Kingdom database, the research team found 1672 cases of C. difficile among patients registered in community practices.  Among them was a subset of patients with community-acquired infections.  Since C.difficile is ordinarily considered a hospital-acquired infection, it was a surprise that 70% of the patients had not been hospitalized in the year prior to their infection and 50% of them had not had antibiotic treatment within the past three months.  The patients with C.difficile were matched to controls in the practices without the disease.

The team concluded:

“The use of acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk of community-acquired C difficile. The unexpected increase in risk with non-steroidal anti-inflammatory drug use should be investigated further.”

In a news release from McGill University where the research was done, Dr. Sandra Dial said,

 ”We believe drugs that reduce gastric acidity provide a more hospitable environment within which C. difficile bacteria can colonize.”

Dr. Dial and the research team at McGill compared rates of community-acquired c.difficile in  the United Kingdom General Practice Research Database (GPRD over ten years.  In discussing the increased incidence, Dr. Dial said,

 ”In 1994 there was less than one C. difficile case per 100,000 people in the database, By 2004, this number had increased exponentially to 22 cases per 100,000”

Clostridium difficile, also known as C. difficile, is a bacterial microbe that can cause an infection of the bowel. The usual symptoms are diarrhea, fever and abdominal pain.  Careful hand washing is key to preventing its spread.

Proton pump inhibitors include:

•  Prilosec™ (omeprazole)
•  Prevacid™ (lansoprazole)
•  Aciphex™ (rabeprazole)   
•  Protonix™ (pantoprazole)
• Nexium™ (esomeprazole)

H2–receptor antagonists include:

• Tagamet™ (Cimetidine)
• Zantac™  (Ranitidine) 
• Pepcid™ (Famotidine)
• Axid™ (Nizatidine)

McGill University researchers have recently sequenced the genome of the antibiotic-resistant strain of C.difficile that has caused the epidemics of hospital-based intestinal infections in the United States and Canada.

Posted by Kate Murphy on December 26th, 2005
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Season’s Greetings from Kate

In this season of light and joy, I wish all of you health, happiness, and something nice in your stocking.  Writing these posts has been a special blessing for me over the past few months, and I am thankful that C3 – Colorectal Cancer Coalition has made this space available.  I’m looking forward to the coming year with many new posts full of  more effective treatments and even better ways to ease the difficulties of living with colorectal cancer.

So much is on the horizon.  There is real hope that we can end the death and suffering from this disease.  Prevention is becoming a stronger possibility as screening methods improve and awareness that screening prevents colorectal cancer grows..  Treatment of early stage disease is making even more cures possible.  And survival times in advanced colorectal cancer has doubled with current therapy.

Enjoy the coming days.  Eat cookies, walk in the snow (or the sunshine), buy a bone for the dog, hug the children, sing even if you can’t carry a tune.  Tonight many candles on my mantle will be lit and shining for all of you.

Love from me and Santa.

Kate

Posted by Kate Murphy on December 24th, 2005
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High-dose Senna effectively used as a preparation for colonoscopy.

Gastroenterologists in Italy compared senna tablets to conventional PEG lavage as a preparation for screening colonoscopy.  They rated overall colon cleansing, cleansing of the right colon, safety, and patient acceptance in a randomized study reported in the December issue American Journal of Gastroenterology.

Outpatients who had been referred for elective colonoscopy were randomly prescribed either 24 tablets of 12 mg. senna, taken in two doses on the day prior to colonoscopy or standard 4 liter polyethylene glycol-electrolyte solution (PEG-ES).

The gastroenterologist who performed the colonoscopy did not know which preparation the individual patient had used and evaluated the quality of colon cleansing.  Patients answered questions about tolerance, discomfort, adverse events, and their ability to complete the entire preparation.

The quality of colon cleansing, overall tolerance of the prep technique, and compliance were significantly better with the senna group. 

• overall cleansing was excellent or goo in 90.6% of senna patients compared to 79.7% of PEG-ES.
• 7.3% of PEG-ES patients had to be rescheduled for another colonoscopy because of insufficient cleansing compared to 2.8% of those using senna.
• incidence of adverse events was similar in the two groups, but patients receiving senna had significantly less nausea and vomiting, although they reported more abdominal pain.

The study team, headed by Franco Radaelli, M.D.concluded:

An oral high dose of senna is a valid alternative to standard PEG-ES for outpatient colonoscopy preparation.

Posted by Kate Murphy on December 21st, 2005
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Blood DNA screening test for colon cancer being developed

In a press release on December 19, 2005, [Epigenomics](http://www.epigenomics.com/en/Company/), a Berlin-based company, released results from three large clinical studies that demonstrated a positive correlation between changes in DNA in a blood test and colorectal cancer. Epigenomics is developing diagnostic tools that build on the relationship between DNA methylation and cancer.

Using an ordinary blood draw, the test detects abnormal patterns in methyl *tags* on the DNA of key genes that affect how cells divide. In cancer, very frequent increases or decreases in DNA methylation contribute to unchecked growth of cells into tumors.

In three independent studies, the molecular test developed by Epigenomics showed sensitivity of 51%, 65%, and 50% in identifying blood from people with colorectal cancer. The test was also highly specific — there were almost no false positive readings in blood from people who did not have cancer. Importantly, there was no difference in the stage of cancer. The test was as sensitive for early cancers as for more advanced ones. The test also identified colorectal cancers despite their location.

The new process studied blood samples from 600 colorectal cancer patients in all stages of the disease, 600 patients with medical conditions that might confuse test results, and 600 normal controls who had all had colonoscopy and were cancer-free.

While not as sensitive as colonoscopy, the new test is more sensitive and more specific than *fecal occult blood testing (FOBT)* which is used for screening large groups of people for colorectal cancer by searching for hidden blood in stool.

In their press releast, the company wrote:

Epigenomics believes that this diagnostic, which works by interpreting changes in DNA methylation, has the potential to support large-scale, general population colorectal cancer screening since early detection of colorectal cancer significantly improves treatment outcome. The test targets asymptomatic men and women over the age of 50 who are recommended to take an early detection test for colorectal cancer on a regular basis.

The current test is based on a single marker. The company believes that additional markers may make it more sensitive and that standardizing the way blood samples are handled may also improve it.

Epigenomics is working in collaboration with Roche Diagnostics to develop and market the blood test.

Additional information about the test is in the *Seattle Times* and the *Houston Chronicle*. Epigenomics has a subsidary in Seattle.

Posted by Kate Murphy on December 19th, 2005
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