Risk for colorectal adenocarcinoma in pernicious anemia: a population-based cohort study

Article Abstract:

The identification of individuals at high risk for colon cancer is essential for an aggressive approach to preventing this disease. About six percent of the United States population will develop this common malignancy. Previous studies have suggested that individuals with pernicious anemia may be at increased risk for colon cancer but, thus far, reports have been inconclusive. Pernicious anemia is a serious blood condition characterized by a progressive decrease in red blood cells, muscle weakness, and gastrointestinal and neural disturbances; it can be successfully treated with vitamin B-12, iron and folic acid. A possible link between colon cancer and pernicious anemia is the high levels of gastrin (a digestive hormone) which often accompany pernicious anemia and may be associated with tumor growth. The complete medical history of 150 subjects who had pernicious anemia and lived in a particular city was reviewed retrospectively (the period covered was 1950 through 1979) and the incidence of cancers was recorded. These results were then compared with the expected rates of rectal and colon cancer in the local population. Among the patients with pernicious anemia, 14 cases of colorectal cancer were detected whereas 10.5 cases were expected. Individuals with pernicious anemia did not have a statistically significant increased risk for colorectal cancer. However, these patients may have a slightly higher than normal risk for colorectal adenocarcinoma (malignancy arising from glandular epithelium). The highest rates occurred in the five-year period after the initial diagnosis of pernicious anemia was made. During this period seven cancer cases occurred but only 1.7 were expected. No increased risk was observed for these individuals prior to or shortly after diagnosis of pernicious anemia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Colorectal cancer, Adenocarcinoma, Pernicious anemia

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A questionnaire for functional bowel disorders

Article Abstract:

The functional bowel disorders consist of gastrointestinal conditions that cannot be ascribed to known structural abnormalities, or infectious or metabolic causes. Functional gastrointestinal symptoms are very common, affecting almost four million people between 1979 to 1981, and accounting for 427,000 hospitalizations in 1984. Because little is known about the underlying disease mechanisms of these disorders, diagnosis is often made by excluding other disorders. The development of standard criteria for diagnosing functional bowel disorders would improve diagnostic certainty, enhance physician and patient satisfaction, and standardize the selection of patients for clinical study. A questionnaire was recently developed to distinguish persons with functional bowel disorders, such as non-ulcer dyspepsia and irritable bowel syndrome, from normal persons or patients with gastrointestinal disease of known cause. Common symptoms of functional bowel disorders include long-lasting, diffuse pain associated with eating and bowel disturbance or change in bowel habits, and are more common in women and younger persons. On the basis of this study, nonulcer dyspepsia was associated with upper abdominal and night pain, whereas lower abdominal pain and bowel disturbance were more common in irritable bowel syndrome. Although a questionnaire cannot replace the clinician's assessment of the patient or the planning of treatment, it may be beneficial in terms of time and cost in helping the physician make a more specific diagnosis of gastrointestinal symptoms with no known cause. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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A patient questionnaire to identify bowel disease

Article Abstract:

The functional bowel disorders comprise gastrointestinal conditions attributable to no known structural abnormalities, or infectious or metabolic causes. Functional gastrointestinal symptoms are very common, affecting almost 4 million people between 1979 to 1981, and accounting for 427,000 hospitalizations in 1984. Because little is known about the underlying mechanisms of these disorders, diagnosis is often made by excluding other disorders. The development of standard criteria for diagnosing functional bowel disorders would improve diagnostic certainty, enhance physician and patient satisfaction, and standardize the selection of patients for clinical study. A questionnaire was recently developed that distinguishes persons with functional bowel disorders, such as non-ulcer dyspepsia and irritable bowel syndrome, from normal persons and patients with gastrointestinal disease of known cause. The questionnaire, which evaluated 46 symptom-related features, was completed by 361 subjects prior to clinical examination, which later indicated 115 cases of functional bowel disease, 101 cases of organic gastrointestinal disease, and 145 healthy persons. The newly-developed questionnaire may be a useful supplement in the diagnosis of functional gastrointestinal symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

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