Observational studies indicate that nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the risk of colorectal neoplasia.
The mechanism of this effect could be via modification of apoptotic activity in colonic mucosa.
A research team from North Carolina, USA, examined grossly normal rectal mucosa in patients with adenomas, and in adenoma-free controls.
Their aim was to assess any association between NSAID use, adenomatous polyps, and apoptosis.
| Regular NSAID users substantially less likely to have adenomas.
Study participants were drawn from consecutive patients who underwent colonoscopy between 1998 and 2000. There were 226 patients with adenomas and 493 controls.
The team obtained biopsy specimens from normal-appearing rectal mucosa 10 cm from the anal verge.
In addition, they scored apoptosis from coded, H&E-stained sections using morphologic methods.
Proliferation was also scored, using whole crypt mitotic counts.
Additionally, univariate and multivariate regression analyses were conducted to estimate crude and adjusted odds ratios (ORs).
The researchers found, after adjusting for sex, age, race, and body mass index, that individuals in the highest tertile of regular NSAID use were substantially less likely to have adenomas (OR 0.4) compared with occasional or nonusers.
Furthermore, compared with the lowest tertile, persons in the highest tertile of rectal mucosal apoptotic activity were much less likely to have adenomas (OR 0.12).
However, NSAID use and apoptotic activity were not correlated and mucosal proliferation was not related to adenomas or NSAID use.
Dr Christopher Martin’s team concluded, “Our observations suggest that NSAID use and higher levels of mucosal apoptosis are independently associated with a lower prevalence of adenomas”.
“The study shows a strong field effect for apoptosis”.