Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study

Abstract

Background-Anthranoid laxatives are the most commonly used purgatives in the therapy of acute and chronic constipation. Recent experimental data and a prospective cohort study provide evidence of a possible risk of anthranoid use for the development of colorectal neoplasms. Materials and methods-We performed a prospective case control study at the University of Erlangen to investigate the risk of anthranoid laxative use for the development of colorectal adenomas or carcinomas. A total of 202 patients with newly diagnosed colorectal carcinomas, 114 patients with adenomatous polyps, and 238 patients (controls) with no colorectal neoplasms who had been referred for total colonoscopy were studied. The use of anthranoid preparations was assessed by standardised interview, and endoscopically visible or microscopic melanosis coli was studied by histopathological examination. Results-There was no statistically significant risk of anthranoid use for the development of colorectal adenomas (unadjusted odds ratio 1.0; 95% CI 0.5-1.9) or carcinomas (unadjusted odds ratio 1.0; 95% CI 0.6-1.8). Even after adjustment for the risk factors age, sex, and blood in the stools by logistic regression analysis the odds ratio for adenomas was 0.84 (95% CI 0.4-1.7) and for carcinomas 0.93 (95% CI 0.5-1.7). Also, there were no diVerences between the patient and control groups for duration of intake. Macroscopic and high grade microscopic melanosis coli were not significant risk factors for the development of adenomas or carcinomas. Conclusion-Neither anthranoid laxative use, even in the long term, nor macroscopic or marked microscopic melanosis coli were associated with any significant risk for the development of colorectal adenoma or carcinoma. (Gut 2000;46:651-655)

Herbal remedies are the main etiologic factor in melanosis coli, a case series study

“…However, recent data, including those from large-scale retrospective, prospective and experimental studies, did not show any increased cancer risk. It is widely accepted that increase in the incidence of adenomas is probably due to easier detection of small adenomas against the black background [2,[19][20][21]. We had only one patient with adenoma and did not see any MC in proximal segments of patients with colon cancer.…”

“…MC refers to brown-to-black pigmentation of colonic mucosa that can occur within several months of regular use and can last for nearly one year after discontinuation of the laxative use. This pigment is related to lipofuscin, a wear-and-tear product, which is released during cellular apoptosis and is contained in mucosal macrophages [2,3].…”

Chronic Constipation: An Evidence-Based Review

“…However, subsequent studies failed to demonstrate an association of anthraquinone laxatives with colorectal carcinomas. 180,[185][186][187][188] Interestingly, one study even hypothesized that the higher rate of adenomas associated with Melanosis coli was due to enhanced ease to spot the white polyps against a dark-colored colon. 189 Taken together, the latest evidence does not support a role of senna in causing colon cancer in rats and humans.…”

The Gut Microbiota as Target for Innovative Drug Development: Perspectives and a Case Study of Inflammatory Bowel Diseases

“…Changes in the colonic motility, absorption, and secretion result in an increased intestinal transit rate and fluid accumulation. Chronic use of these laxatives causes melanosis coli, a deep black pigmentation of the colon mucosa but whether there is an association with colorectal cancer, is still controversial (Van Gorkom et al, 1999;Nusko et al, 2000). Besides the interest in the microbial conversion of health-promoting components from ingested foodstuffs, much attention is also given to the role of intestinal bacteria in the conversion of ingested drugs, environmental or food contaminants or xenobiotics in general.…”