Bowel-Cleansing and Nephropathy
Acute phosphate nephropathy has been reported in 22 patients who used oral sodium phosphates for bowel cleansing, according to a warning issued by the Food and Drug Administration.
In 21 of the cases, the patients had used an oral sodium phosphate solution (such as Fleet Phospho-soda or Fleet ACCU-PREP, made by C.B. Fleet Company). One case was documented in a patient who used oral sodium phosphate tablets (Visicol, made by Salix Pharmaceuticals Inc.). No cases of kidney failure have been associated with OsmoPrep tablets (also made by Salix), which were recently approved for bowel cleansing.
Individuals at increased risk of acute phosphate nephropathy include those of advanced age, those with kidney disease or decreased intravascular volume, and those using medications that affect renal perfusion function (diuretics, angiotensin II receptor blockers, ACE inhibitors, and possibly NSAIDs).
Physicians can find more information from the FDA on the diagnosis of this condition and considerations for choosing a bowel cleanser for patients, along with a patient information sheet, by visiting
www.fda.gov/medwatch/safety/2006/safety06.htm#phosphate
Colorectal Ca Screening Rising Slowly
Use of colorectal cancer screening is on the rise, but still lags behind rates for mammography and Pap tests, the Centers for Disease Control and Prevention reported.
Data from the 2002 and 2004 Behavioral Risk Factor Surveillance System showed that 57.3% of adults aged 50 and older reported having had a fecal occult blood test (FOBT) within the previous year and/or a lower endoscopy (sigmoidoscopy or colonoscopy) within the past 10 years in 2004, compared with 54.4% in 2002.
The proportion who had received an FOBT within 1 year dropped from 21.8% in 2002 to 18.7% in 2004, while the proportion receiving a lower endoscopy within 10 years rose from 45.2% to 50.6% in the same time period, the CDC said (MMWR 2006;55:308–11).
By state, the proportions screened by any method in 2004 ranged from 47.9% in Mississippi to 68.2% in Minnesota. A total of 14 states plus the District of Columbia reported that 60% or more of their residents aged 50 and older had been screened in 2004, compared with just 7 states and the District of Columbia in 2002.
The CDC has initiated several programs designed to increase colorectal cancer screening rates, including demonstration programs in five states for low-income individuals aged 50 and older who have no health insurance coverage for colorectal cancer screening. The CDC also has funded 21 state programs to implement specific colorectal cancer prevention strategies through National Comprehensive Cancer Control Program initiatives (
www.cdc.gov/cancer/ncccp/index.htm
IBD-Related Colorectal Ca Not Worse
Colorectal cancer is no more lethal to patients with inflammatory bowel disease than it is among the general population, according to a large, retrospective study.
Investigators at the Mayo Clinic, Rochester, Minn., identified 290 patients diagnosed with inflammatory bowel disease (IBD)-related colorectal cancer (CRC) between 1976 and 1996. Of those, 241 had chronic ulcerative colitis and 49 had Crohn's disease. The IBD group was compared with 290 controls with sporadic CRC matched on age, sex, and tumor stage at presentation (Clin. Gastroenterol. Hepatol. 2006;4:335–42).
IBD-related cancers were spread more evenly throughout the colon, whereas sporadic cancers were more likely to be left-sided. Between 56% and 63% of patients with IBD-associated CRC had TNM (tumor-regional nodes-metastasis) classification stage I or II disease. Chronic ulcerative colitis-related tumors were more likely to be multiple. Tumor grades tended to be higher, and mucinous differentiation was more frequent, among those with IBD, the authors said.
Despite these findings, patients with IBD-associated CRC had no significant difference in their overall 5-year survival rate, compared with patients with sporadic CRC. “A total of 163 patients in the IBD-associated CRC subgroup (56%) died during the [5-year] follow-up period, whereas 164 patients died in the sporadic CRC subgroup (57%),” they added. “Secondary analyses suggested that certain subgroups may have a worse prognosis.”
“Interestingly, in our population, approximately one-half of patients with Crohn's disease-related cancers developed tumors at subsites without any endoscopic or pathologic evidence of prior colonic inflammation,” the investigators said, speculating that, based upon a relatively small number of cases, inflammation may not be a mandatory prerequisite to tumorigenesis among all IBD patients.