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Chiba T, Wang T, Kikuchi S. Colonoscopic Resolution of Melanosis Coli After Cessation of Senna Laxative Use. Int Med Case Rep J 2024; 17:783-787. [PMID: 39282237 PMCID: PMC11402352 DOI: 10.2147/imcrj.s475869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 08/20/2024] [Indexed: 09/18/2024] Open
Abstract
Melanosis coli occurs with the administration of stimulant laxatives for the relief of constipation. However, the duration of macroscopic improvement of melanosis coli after discontinuation of anthracene laxatives is not well understood. We describe the case of an 81-year-old female diagnosed with melanosis coli via colonoscopy who had been taking senna laxatives for 5 years. Seven months after cessation of senna laxatives, colonoscopy showed no melanosis coli in the colon. This impressive report describes the observation of melanosis coli with colonoscopy; 7 months after the withdrawal of senna stimulant laxatives, melanosis coli resolved.
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Affiliation(s)
- Toshimi Chiba
- Division of Internal Medicine, Department of Oral Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Ting Wang
- Division of Internal Medicine, Department of Oral Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Satoshi Kikuchi
- Department of Gastroenterology, Sanai Hospital, Morioka, Iwate, Japan
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2
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Wang Y, Li L, Niu X, Gao F, Chai N, Linghu E. Melanosis coli: a contrast effect or an oncogenic effect? A large-scale retrospective cohort study. Int J Colorectal Dis 2023; 38:63. [PMID: 36884096 DOI: 10.1007/s00384-023-04357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Melanosis coli is characterized by brown mucosa with pigmentation. Studies have showed an increased adenoma detection rate in melanosis patients, whether it is caused by a contrast effect or an oncogenic effect is still controversial. The detection of serrated polys in melanosis patients remains unknown. AIMS The study aimed to clarify the correlation of adenoma detection rate with melanosis coli and discuss outcomes in less-experienced endoscopists. Serrated polyp detection rate was also been investigated. METHODS A total of 2150 patients and 39,630 controls were enrolled. A propensity score matching method was used to balance covariates between the two groups. The detection of polyps, adenomas, serrated polyps, and their features was analyzed. RESULTS The polyp detection rate (44.65% vs 41.01%, P = 0.005) and adenoma detection rate (30.34% vs 23.92%, P < 0.001) were significantly higher, and the serrated polyp detection rate (0.93% vs 1.58%, P = 0.033) was significantly lower in melanosis coli. The percentage of low-risk adenomas (44.60% vs 39.16%, P < 0.001) and polyps with 6 to 10 mm in size (20.16% vs 16.21%, P < 0.001) were higher in melanosis coli. The detection of large serrated polyps was lower (0.11% vs 0.41%, P = 0.026) in melanosis coli. CONCLUSION Melanosis coli correlates with an increased adenoma detection rate. The detection of large serrated polyps was lower in melanosis patients. Melanosis coli may not be considered a precancerous lesion.
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Affiliation(s)
- Yan Wang
- Nankai University School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Longsong Li
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Xiaotong Niu
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Fei Gao
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Ningli Chai
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China.
| | - Enqiang Linghu
- Nankai University School of Medicine, Nankai University, Tianjin, 300071, China.
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China.
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3
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Hsieh Y. Melanosis coli: A naturally enhanced contrast for colonoscopy? ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Yu‐Hsi Hsieh
- Division of Gastroenterology, Department of Internal Medicine Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation Chiayi Taiwan
- School of Medicine Tzu Chi University Hualien Taiwan
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Zhou JY, Wang J, Ning BF, Hu YD, Zhao Q, Tan W, Shi PM, Yuan ZL, Feng XW, Chen JDZ, Xie WF. Sustained ameliorating effects and autonomic mechanisms of transcutaneous electrical acustimulation at ST36 in patients with chronic constipation. Front Neurosci 2022; 16:1038922. [PMID: 36478881 PMCID: PMC9720110 DOI: 10.3389/fnins.2022.1038922] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND AND AIMS The treatment of chronic constipation is still a great challenge in clinical practice. This study aimed to determine the efficacy and sustained effects of transcutaneous electrical acustimulation (TEA) at acupoint ST36 on the treatment of chronic constipation and explore possible underlying mechanisms. METHODS Forty-four patients with chronic constipation were recruited and randomly assigned to a TEA group or sham-TEA group. A bowel diary was recorded by the patients. The Patient Assessment of Constipation Symptom (PAC-SYM) and the Patient Assessment of Constipation Quality of Life (PAC-QoL) questionnaires were administered during each visit. Anal and rectal functions were evaluated with anorectal manometry. Autonomic functions were assessed by the special analysis of heart rate variability derived from the ECG recording. RESULTS Compared with sham-TEA, 2-week TEA treatment significantly increased the number of spontaneous bowel movements (SBMs) (5.64 ± 0.54 vs. 2.82 ± 0.36, P < 0.001) and lowered the total scores of PAC-SYM (0.90 ± 0.14 vs. 1.35 ± 0.13, P < 0.001) and PAC-QoL (0.89 ± 0.13 vs. 1.32 ± 0.14, P < 0.05). TEA improved symptoms, as reflected by a reduction in the straining (P < 0.001), the incomplete defecation (P < 0.05), the frequency of emergency drug use (P < 0.05), the days of abdominal distension (P < 0.01) and an increase in intestinal satisfaction (P < 0.01). Interestingly, the effects of TEA on the improvement of weekly SBMs sustained four weeks after the cessation of treatment (P < 0.001). Anorectal manometry indicated that 2-week treatment of TEA lowered the threshold of first sensation (P < 0.05), desire of defecation (P < 0.01) and maximum tolerable volume (P < 0.001) compared with sham-TEA group. TEA also significantly enhanced vagal activity, reflected by high-frequency band of heart rate variability, compared with sham-TEA (57.86 ± 1.83 vs. 48.51 ± 2.04, P < 0.01). CONCLUSION TEA ameliorates constipation with sustained effects, which may be mediated via improvement of rectal sensitivity and enhancement of vagal activity. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/], identifier [ChiCTR210004267].
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Affiliation(s)
- Jie-Yi Zhou
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jian Wang
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Bei-Fang Ning
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ye-Dong Hu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qi Zhao
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wei Tan
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Pei-Mei Shi
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zong-Li Yuan
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xin-Wei Feng
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jiande D. Z. Chen
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, United States
| | - Wei-Fen Xie
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
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Zhao W, Chen J, Xing H, Yu J, Liu Q. Case report: Melanosis coli combined with colon cancer, causality or coincidence? Front Surg 2022; 9:973883. [PMID: 36117832 PMCID: PMC9471420 DOI: 10.3389/fsurg.2022.973883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
The habitual use of laxative containing anthraquinone glycosides is considered to be the main cause of melanosis coli (MC). In the past, most scholars considered MC to be a benign and reversible disease. However, new evidence has emerged that MC may increase the risk of colon cancer. Here, we report a case of a 48-year-old woman diagnosed with MC and colon cancer. Through a literature review of previous basic and clinical studies, we summarize existing evidence that reveals the possible association between MC and colon cancer. Although this case cannot establish causality between MC and colon cancer, a high level of clinical vigilance for occurrence of colon cancer in patients with MC should be maintained.
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Affiliation(s)
- Wei Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianan Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongbin Xing
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou, China
| | - Jun Yu
- Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Correspondence: Jun Yu Qian Liu
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Correspondence: Jun Yu Qian Liu
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Zhang Y, Zhan TT, Dong ZY, Sun HH, Wang JW, Chen Y, Xu SC. Melanosis coli: A factor not associated with histological progression of colorectal polyps. J Dig Dis 2022; 23:302-309. [PMID: 35661415 PMCID: PMC9541455 DOI: 10.1111/1751-2980.13100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In this study we aimed to investigate the association of melanosis coli (MC) and the colorectal polyp detection rate (PDR). METHODS In all, 1104 MC patients and 62 181 non-MC participants were enrolled. And 2208 controls were matched by participants' age and gender, and quality of bowel preparation using the propensity score matching (PSM) method. Additionally, 490 polyps in MC and 980 in controls matched by age and gender, and size and location of polyps were analyzed. The association of PDR and pathological features of polyps with MC were also analyzed. RESULTS MC patients showed a higher PDR (44.3% vs 39.3%, P = 0.006) and detection rate of low-grade adenoma (45.4% vs 36.7%, P = 0.002) but fewer large polyps (≥10 mm) (18.8% vs 26.9%, P = 0.001), fewer polyps in the left colon (33.5% vs 40.0%, P = 0.018), and a lower detection rate of advanced adenoma/adenocarcinoma (17.4% vs 24.3%, P = 0.003) than the matched controls. On multivariate logistic regression analysis, MC was independently associated with an increased PDR (odds ratio 1.184, 95% confidence interval 1.045-1.343, P = 0.008). Analysis targeting polyps showed that there were significant differences in age, gender, location, and pathology (P < 0.001) between polyps with and without MC. However, after adjusting for participants' age and gender, size and location of polyps, there was no difference between the two groups in pathology (P = 0.635). CONCLUSION MC is independently associated with increased colorectal PDR, but not with histological progression of polyps.
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Affiliation(s)
- Yan Zhang
- Department of Gastroenterology, Tongji Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Ting Ting Zhan
- Department of Gastroenterology, Tongji Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zhi Yu Dong
- Department of Gastroenterology, Tongji Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Hui Hui Sun
- Department of Gastroenterology, Tongji Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Jun Wen Wang
- Department of Gastroenterology, Tongji Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Ying Chen
- Department of Gastroenterology, Tongji Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Shu Chang Xu
- Department of Gastroenterology, Tongji Hospital, School of MedicineTongji UniversityShanghaiChina,Tongji Institute of Digestive Diseases, School of MedicineTongji UniversityShanghaiChina
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7
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Katsumata R, Manabe N, Fujita M, Ayaki M, Sunago A, Kamada T, Monobe Y, Kawamoto H, Haruma K. Colorectal neoplasms in melanosis coli: a survey in Japan and a worldwide meta-analysis. Int J Colorectal Dis 2021; 36:2177-2188. [PMID: 34156546 DOI: 10.1007/s00384-021-03970-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The association between melanosis coli (MC) and colorectal neoplasms remains unclear. Thus, we primarily aimed to clarify the epidemiology of MC in the Japanese population, identify the relationship between the use of anthranoids and MC, and determine the prevalence of detected intestinal lesions in patients with MC. We subsequently conducted a meta-analysis of published data, including our results, to summarize the influence of MC on the prevalence of colonic neoplasms. METHODS We conducted a retrospective survey in Japan to investigate the effects of MC on intestinal disorders. The prevalence of colorectal neoplasms and ileal ulcers was evaluated by colonoscopy, and the clinical characteristics of the participants were investigated using an electronic database. Odds ratios for colorectal neoplasms were calculated. We also performed a meta-analysis using Review Manager to reveal the comprehensive relationship between MC and colorectal neoplasms. RESULTS We enrolled 690 Japanese participants in the primary study. The prevalence of regular anthranoid use was significantly higher in the MC group than in the control group (50.9% vs. 6.5%, p < 0.01). Hyperplastic/inflammatory polyps and adenomas were more frequently detected in the MC group than in the control group. In a meta-analysis of five studies, a significantly higher prevalence of hyperplastic/inflammatory polyps and adenomas was reported in the MC group than in the control group, while the incidence of adenocarcinoma was not significantly different between the two groups. CONCLUSION Although hyperplastic polyps and adenomas were more frequently detected in MC patients, MC was not associated with an elevated risk of colorectal cancer.
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Affiliation(s)
- Ryo Katsumata
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama City, Okayama, 7008505, Japan
| | - Noriaki Manabe
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama City, Okayama, 7008505, Japan.
| | - Minoru Fujita
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama City, Okayama, 7008505, Japan
| | - Maki Ayaki
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama City, Okayama, 7008505, Japan
| | - Aya Sunago
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yasumasa Monobe
- Department of Pathology, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
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K V A. Melanosis coli: a case report. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Melanosis coli is a benign condition characterized by deposition of lipofuscin in colonic mucosa due to long-term laxative use.
Case presentation
Here I am reporting a case of an 85-year-old man who presented with constipation, with a history of long-term herbal medication intake as laxatives, and upon evaluation, he was found to have melanosis coli.
Conclusion
Melanosis coli is a common adverse effect of chronic laxative use which is more common in elderly population with constipation.
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Dong Z, Sun H, Li B, Zhang Q, Sun K, Wang Z, Qian X, Wang J, Zhan T, Jiang Y, Chen Y, Xu S. Comprehensive evaluation of the learning curve to achieve satisfactory adenoma detection rate. J Gastroenterol Hepatol 2021; 36:1649-1655. [PMID: 33105040 DOI: 10.1111/jgh.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The number of colonoscopies required to reach satisfactory adenoma detection rate (ADR) is not well established. The aim of this study was to identify the appropriate number of procedures required to attain satisfactory ADR for those well-trained endoscopists who have a cecal intubation rate (CIR) ≥ 90% and start to perform colonoscopy independently. METHODS All endoscopists with compelete independent colonoscopy data during career in our database were enrolled. The number of procedures required to achieve ADR ≥ 20% was identified by cumulative summation (Cusum), learning curve Cusum (LC-Cusum), and moving average method. Mixed effect logistic regression model was developed to determine the relationship between endoscopist as well as patient-related factors and adenoma detection. RESULTS A total of 24 943 procedures and 14 endoscopists were enrolled. By Cusum analysis, the interest point was at 207 procedures. By LC-Cusum analysis, 71% (10/14) and 86% (12/14) of endoscopists had attained satisfactory ADR after 200 and 300 procedures, respectively. By moving average method, endoscopists reached a mean ADR of 20% at 216 and 261 procedures over blocks of 50 and 100 procedures, respectively. The total number of procedures, number of daily procedures, patient age and gender, bowel preparation, sedation, and diverticulosis were significantly associated with adenoma detection. CONCLUSIONS This is the first study to investigate the learning curve of ADR for those well-trained endoscopists who have a CIR ≥ 90% and start to perform colonoscopy independently. Two hundred procedures might be an optimal number required to reach an ADR ≥ 20%.
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Affiliation(s)
- Zhiyu Dong
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huihui Sun
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bo Li
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiongmei Zhang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kejing Sun
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenxiang Wang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xue Qian
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junwen Wang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Zhan
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuanxi Jiang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuchang Xu
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Melanosis coli: A comprehensive review. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:266-272. [PMID: 32094046 DOI: 10.1016/j.gastrohep.2020.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 01/11/2023]
Abstract
Melanosis coli (MC) is a common condition characterized by a black or brown pigment deposited in the colorectal mucosa. It is a reversible condition that is influenced by many factors, such as living habits and bowel function. However, the epidemiology and etiology of MC are still unclear. Most studies show that there is a significant correlation between the use of anthraquinone laxatives and the occurrence of MC. At present, the mechanism of the apoptosis theory is widely recognized as regards the pathogenesis of MC. There is no specific clinical manifestation of MC, and its diagnosis is mainly based on a complimentary examination, such as endoscopic and histopathological tests. General treatment, such as changing living habits, is preferred, and medical or surgical treatment should not be considered in the absence of serious malignancy. The aim of this review is to systematically present and outline the concepts of the epidemiology, etiology, histopathology, pathogenesis, clinical manifestations, diagnosis and treatment of MC, in order to improve the understanding of this condition.
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Retrospective study on melanosis coli as risk factor of colorectal neoplasm: a 3-year colonoscopic finding in Zhuhai Hospital, China. Int J Colorectal Dis 2020; 35:213-222. [PMID: 31823053 DOI: 10.1007/s00384-019-03435-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Melanosis coli (MC) is a colonoscopic finding in which the colonic mucosa appears darkly pigmented than usual and generally caused by extended anthranoid laxative use. METHODS We performed a retrospective study at Zhuhai Hospital to investigate the risk of MC for CR neoplasm development. A total of 12,776 patients who underwent colonoscopy from 2013 to 2016 including 250 diagnosed with MC and 500 controls were included in this study. Odds ratios (OR) and 95% confidence intervals (95%CI) for associations of MC with CR neoplasm detection were estimated using univariate and multivariable multinomial logistic analyses for known risk factors. RESULTS The presence of MC was associated with a significant increase in the CR neoplasm detection rate compared with controls (OR = 1.701, 95% CI = 1.252-2.31; P = 0.001). The effect was also observed in different tumor sites, age group, gender, and lifestyle. Using univariate multinomial analysis, patients with MC were significantly associated with both hyperplastic polyp (OR = 2.069, 95% CI = 1.253-3.415; P = 0.005) and low-grade (LG) adenoma (OR = 1.585, 95% CI = 1.115-2.254; P = 0.010). However, there was no significant difference with adenocarcinoma (OR = 1.701, 95% CI = 0.990-2.924; P = 0.055). Using multivariate multinomial analysis, MC patients remained associated with increased hyperplastic polyp (OR = 1.870, 95% CI = 1.119-3.125; P = 0.017) and LG adenoma (OR = 1.474, 95% CI = 1.027-2.114; P = 0.035), but not adenocarcinoma (OR = 1.620, 95% CI = 0.914-2.871; P = 0.098). A significant increase in CR neoplasm rate was observed with drinker, smoker, and elderly patients but not with gender. CONCLUSION Patients with MC were more likely to have both hyperplastic polyp and LG adenoma. If confirmed, such findings could suggest the discontinuation of anthranoid laxative use particularly in the elderly.
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Quantitative Analysis of Melanosis Coli Colonic Mucosa Using Textural Patterns. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10010404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Melanosis coli (MC) is a disease related to long-term use of anthranoid laxative agents. Patients with clinical constipation or obesity are more likely to use these drugs for long periods. Moreover, patients with MC are more likely to develop polyps, particularly adenomatous polyps. Adenomatous polyps can transform to colorectal cancer. Recognizing multiple polyps from MC is challenging due to their heterogeneity. Therefore, this study proposed a quantitative assessment of MC colonic mucosa with texture patterns. In total, the MC colonoscopy images of 1092 person-times were included in this study. At the beginning, the correlations among carcinoembryonic antigens, polyp texture, and pathology were analyzed. Then, 181 patients with MC were extracted for further analysis while patients having unclear images were excluded. By gray-level co-occurrence matrix, texture patterns in the colorectal images were extracted. Pearson correlation analysis indicated five texture features were significantly correlated with pathological results (p < 0.001). This result should be used in the future to design an instant help software to help the physician. The information of colonoscopy and image analystic data can provide clinicians with suggestions for assessing patients with MC.
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Lecomte T, Chautard R, Orain I. A melanosis coli associated with a large flat adenoma of the cecum. Clin Res Hepatol Gastroenterol 2019; 43:228-229. [PMID: 30447908 DOI: 10.1016/j.clinre.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/11/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Thierry Lecomte
- Tours university, 37000 Tours, France; Department of hepatogastroenterology and digestive oncology, university hospital, 37044 Tours cedex 9, France.
| | - Romain Chautard
- Department of hepatogastroenterology and digestive oncology, university hospital, 37044 Tours cedex 9, France
| | - Isabelle Orain
- Department of pathology, university hospital, 37044 Tours cedex 9, France
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Abu Baker F, Mari A, Feldman D, Suki M, Gal O, Kopelman Y. Melanosis Coli: A Helpful Contrast Effect or a Harmful Pigmentation? CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2018; 11:1179552218817321. [PMID: 30574001 PMCID: PMC6299301 DOI: 10.1177/1179552218817321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 11/09/2018] [Indexed: 01/17/2023]
Abstract
Background Melanosis coli, a brown discoloration of colonic mucosa, is considered as a benign condition mainly observed in patients under chronic anthranoid laxatives. Recent data link this condition with an increased adenoma detection rate. Moreover, its tumorigenic potential and possible association with the development of colorectal cancer remains uncertain. We conducted this study to compare the polyp detection rate and colorectal cancer diagnosis in patients with melanosis against matched control group without melanosis. Patients and methods A retrospective single-center study. Patients diagnosed with melanosis coli on colonoscopy over a 15-year period were included. Each melanosis coli patient was matched with three controls by age, gender, setting (inpatient/outpatient), and procedure's indication. Polyp detection rate and diagnosis of colorectal cancer were recorded and compared between the groups before and after adjustment for bowel preparation. Results A cohort of 718 patients with melanosis and 2154 controls were included. The polyp detection rates were 33.4% and 21.8% of melanosis and control groups, respectively (P < .001). Melanosis coli, however, was associated with less diagnosis of colorectal cancer than controls (0.3% vs 3.9%; P < .001). In multivariate analysis, melanosis diagnosis on endoscopy was significantly associated with higher polyp detection rate (odds ratio [OR] = 1.986, 95% confidence interval [CI]: 1.626-2.425; P value < .01). Conclusions Melanosis coli is not associated with increased diagnosis of colorectal cancer. It is associated, however, with enhanced polyp detection likely due to chromo-endoscopy-like effect.
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Affiliation(s)
- Fadi Abu Baker
- Fadi Abu Baker, Department of Gastroenterology and Hepatology, Hillel Yaffe Medical center, Technion Faculty of Medicine, Hashalom st., Hadera 38100, Israel.
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Wang S, Wang Z, Peng L, Zhang X, Li J, Yang Y, Hu B, Ning S, Zhang B, Han J, Song Y, Sun G, Nie Z. Gender, age, and concomitant diseases of melanosis coli in China: a multicenter study of 6,090 cases. PeerJ 2018; 6:e4483. [PMID: 29568709 PMCID: PMC5845562 DOI: 10.7717/peerj.4483] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/20/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUNDS AND AIMS Melanosis coli (MC) is a noninflammatory, benign, and reversible colonic disorder, but its detection rates in China are unclear. We therefore aimed to analyze the epidemiological characteristics of MC in China. METHODS We assessed the detection rates, associated factors and concomitant diseases of MC in the patients who underwent colonoscopy at eight medical centers across five regions of China between January 2006 and October 2016. All data were procured from the electronic database established at each participating institutions. RESULTS Among the 342,922 included cases, MC was detected in 6,090 cases (detection rate = 1.78%, 95% confidence interval, 1.73%-1.82%) at a mean age of 60 years. The detection rate gradually increased yearly, and along with the increasing age regardless of gender, while a rapid increase presented in the patients ≥60 years of age (0.58% for ≤25 years, 1.22% for 25-59 years, and 3.19% for ≥60 years). The detection rate was higher in females than in males; however, the rate of per-year increase was higher in males than in females at age of ≥60 years, which was 1.85-fold of that in females. Among cancer, polyp, inflammation, and diverticula, polyp was the most common concomitant disease of MC and identified in 41.72% of MC patients. CONCLUSIONS MC detection rates were increased annually and elevated in older patients, particularly in male patients. Males in the elderly population of ≥60 years were most likely to have MC. Colonic polyp is the most common concomitant disease of MC.
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Affiliation(s)
- Shufang Wang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Zikai Wang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Lihua Peng
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Xiuli Zhang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Jianfeng Li
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Yunsheng Yang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Bing Hu
- Department of Gasterology, West China Hospital, Chengdu, China
| | - Shoubin Ning
- Department of Gasterology, Air Force General Hospital, Beijing, China
| | - Bingyong Zhang
- Department of Gasterology, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Junling Han
- Department of Gastrointestinal Endocrinology, 187 Military Hospital, Haikou, China
| | - Ying Song
- Department of Gasterology, Xian Central Hospital, Xian, China
| | - Gang Sun
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
- Departmenf of Gasterology, Hainan Branch of the Chinese PLA General Hospital, Sanya, China
| | - Zhanguo Nie
- Department of Gasterology, General Hospital of the Xinjiang Military Region, Urumqi, China
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Melanosis coli: Harmless pigmentation? A case-control retrospective study of 657 cases. PLoS One 2017; 12:e0186668. [PMID: 29088250 PMCID: PMC5663380 DOI: 10.1371/journal.pone.0186668] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/05/2017] [Indexed: 11/19/2022] Open
Abstract
Backgrounds and aims The association of melanosis coli with the development of colorectal polyps remains uncertain. Methods From a total of 18263 patients who had received colonoscopy in our hospital, 219 with melanosis coli cases and 438 controls matched by age and sex (at 1:2 ratio) were included in this study. The association of incidence, number, location, and pathology of colorectal neoplasm with grades and distribution of melanosis coli were analyzed. Results Melanosis coli was associated with significantly more colorectal polyps than control, a higher incidence of numerous colorectal polyps (number ≥ 20) (7.3% vs 0.5%; p < 0.001), and higher number of small colorectal polyps (diameter ≤ 5 mm; p < 0.01). Patients with melanosis coli had higher incidences of low-grade adenomas (31.1% vs 23.3%, p < 0.05) and non-adenoma polyps (20.1% vs 12.8%, p < 0.05) than the controls. On multivariate analysis, melanosis coli was independently associated with increased detecting rates of low grade adenoma (OR = 1.54; 95%: 1.06–2.23; p < .05), non-adenoma polyp (OR = 1.72; 95%: 1.11–2.70; p < .05) and numerous polyps (OR = 16.2, 95%: 3.66–71.6; p < .05). There was no significant difference in the incidence of high-grade adenomas or adenocarcinomas in the two population groups, but the numbers of these lesions were insufficient to permit firm conclusions. No significant differences in incidence, number, and pathology of colorectal polyps between individuals with melanosis coli of three different grades of severity were found. Melanosis located predominantly in the right colon had an interestingly lower incidence of colonic polyps in right colon than did melanosis located predominantly in the left colon or total colon (8.9% vs. 26.3%, 24.0%, p < 0.05). Patients with melanosis coli had significantly more nonspecific distal ileal ulcers than did controls (8.0% vs 0%, p < 0.001). Conclusion Melanosis coli is associated with a higher incidence and number of colonic non-adenoma polyps and low-grade adenomas, and higher incidence of distal ileal ulcers. Melanosis coli may not be a harmless pigmentation, but a sign of chronic injury of colonic and intestinal mucosa.
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