Korean J Gastroenterol.  2009 Oct;54(4):220-226. 10.4166/kjg.2009.54.4.220.

Prevalence of Colorectal Adenoma Is Increased in Patients with Gastric Adenoma

Affiliations
  • 1Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. dshskim@chonnam.ac.kr

Abstract

BACKGROUND/AIMS
It has been reported that patients with gastric cancer may be at increased risk of synchronous or metachronous colorectal cancer. However, the incidence of colorectal adenoma in patients with gastric adenoma has not been discussed earlier. The aims of this study were to investigate the incidence of colorectal adenoma and to evaluate the necessity of colonoscopic surveillance in patients with gastric adenoma.
METHODS
We performed colonoscopy in 221 patients with gastric adenoma between January 2002 and June 2008. As a control group, 387 consecutive patients without gastric adenoma on gastroscopy who underwent colonoscopy were included. We retrospectively examined the endoscopic and colonoscopic findings as well as the clinicopathologic features.
RESULTS
Colorectal adenoma were diagnosed in 57.5% (127/221) of the gastric adenoma group and 38.0% (147/387) of the control group (p<0.001). Univariate analysis demonstrated that gender, age, past history of diabetes, and past history of gastric adenoma were associated with the risk of colorectal adenoma. Multivariate analysis demonstrated that gender (male, aOR 2.31, 95% CI 1.61-3.31), age (> or =50 years, aOR 2.47, 95% CI 1.53-4.01), past history of diabetes (aOR 2.35, 95% CI 1.32-4.20), and presence of gastric adenoma (aOR 1.63, 95% CI 1.13-2.36) appeared to be independent risk factors for colorectal adenoma.
CONCLUSIONS
The risk of colorectal adenoma increases significantly in patients with gastric adenoma. We suggest that colonoscopic surveillance may be necessary in patients with gastric adenoma.

Keyword

Gastric adenoma; Colorectal adenoma; Colonoscopy

MeSH Terms

Adenoma/*diagnosis/epidemiology
Age Factors
Aged
Colonoscopy
Colorectal Neoplasms/*diagnosis/epidemiology
Diabetes Mellitus/diagnosis
Female
Humans
Male
Middle Aged
Prevalence
Retrospective Studies
Risk Factors
Sex Factors
Stomach Neoplasms/*diagnosis

Reference

1. Ries LA, Wingo PA, Miller DS, et al. The annual report to the nation on the status of cancer, 1973-1997, with a special section on colorectal cancer. Cancer. 2000; 88:2398–2424.
Article
2. 대한민국보건복지부. 한국인 암등록 조사자료 분석보고 서. 2003.
3. Jung SY. 대장암 조기검진을 위한 권고안. Korean J Gastrointest Endosc. 2002; 24:317–320.
4. Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence. Gastroenterology. 2003; 124:544–560.
Article
5. Yoshino K, Asanuma F, Hanatani Y, Otani Y, Kumai K, Ishibiki K. Multiple primary cancers in the stomach and another organ: frequency and the effects on prognosis. Jpn J Clin Oncol. 1985; 15:183–190.
6. Maruyama H, Hasuike Y, Furukawa J, et al. Multiple colorectal carcinomas and colorectal carcinoma associated with extracolonic malignancies. Surg Today. 1992; 22:99–104.
Article
7. Kang HJ, Park DY, Kim KH, Song GA, Lauwers GY. Pathologic diagnosis of gastric epithelial neoplasia. Korean J Gastroenterol. 2008; 52:273–280.
8. Kim WH, Park CK, Kim YB, et al. A standardized pathology report for gastric cancer. Korean J Pathol. 2006; 39:106–113.
9. Chang HJ, Park CK, Kim WH, et al. A standardized pathology report for colorectal cancer. Korean J Pathol. 2006; 2006:193–203.
10. Ansher AF, Lewis JH, Fleischer DE, et al. Hyperplastic colonic polyps as a marker for adenomatous colonic polyps. Am J Gastroenterol. 1989; 84:113–117.
11. Stevens T, Burke CA. Colonoscopy screening in the elderly: when to stop? Am J Gastroenterol. 2003; 98:1881–1885.
Article
12. Rex DK, Khan AM, Shah P, Newton J, Cummings OW. Screening colonoscopy in asymptomatic average-risk African Americans. Gastrointest Endosc. 2000; 51:524–527.
Article
13. Sandler RS, Lyles CM, Peipins LA, McAuliffe CA, Woosley JT, Kupper LL. Diet and risk of colorectal adenomas: macronutrients, cholesterol, and fiber. J Natl Cancer Inst. 1993; 85:884–891.
Article
14. Bayerdorffer E, Mannes GA, Ochsenkuhn T, Kopcke W, Wiebecke B, Paumgartner G. Increased risk of ‘high-risk' colorectal adenomas in overweight men. Gastroenterology. 1993; 104:137–144.
Article
15. Giovannucci E, Colditz GA, Stampfer MJ, et al. A prospective study of cigarette smoking and risk of colorectal adenoma and colorectal cancer in U.S. women. J Natl Cancer Inst. 1994; 86:192–199.
Article
16. Cannon-Albright LA, Skolnick MH, Bishop DT, Lee RG, Burt RW. Common inheritance of susceptibility to colonic adenomatous polyps and associated colorectal cancers. N Engl J Med. 1988; 319:533–537.
Article
17. Grady WM. Genetic testing for high-risk colon cancer patients. Gastroenterology. 2003; 124:1574–1594.
18. Calle EE, Thun MJ. Obesity and cancer. Oncogene. 2004; 23:6365–6378.
Article
19. Kaaks R, Toniolo P, Akhmedkhanov A, et al. Serum C-peptide, insulin-like growth factor (IGF)-I, IGF-binding proteins, and colorectal cancer risk in women. J Natl Cancer Inst. 2000; 92:1592–1600.
Article
20. Chung YW, Han DS, Park YK, et al. Association of obesity, serum glucose and lipids with the risk of advanced colorectal adenoma and cancer: a case-control study in Korea. Dig Liver Dis. 2006; 38:668–672.
Article
21. Cappell MS, Fiest TC. A multicenter, multiyear, case-controlled study of the risk of colonic polyps in patients with gastric polyps. Are gastric adenomas a new indication for surveillance colonoscopy? J Clin Gastroenterol. 1995; 21:198–202.
Article
22. Oh SY, Park DI, Yoo TW, et al. Is gastric cancer a new indication for surveillance colonoscopy? Colon cancer is increased in gastric cancer patients. Korean J Gastroenterol. 2006; 47:191–197.
23. Okamoto N, Morio S, Inoue R, Akiyama K. The risk of a second primary cancer occurring in five-year survivors of an initial cancer. Jpn J Clin Oncol. 1987; 17:205–213.
24. Correa P. Human gastric carcinogenesis: a multistep and multifactorial process–First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. 1992; 52:6735–6340.
25. Thomas JE, Gibson GR, Darboe MK, Dale A, Weaver LT. Isolation of Helicobacter pylori from human faeces. Lancet. 1992; 340:1194–1195.
26. Saunders KE, Shen Z, Dewhirst FE, Paster BJ, Dangler CA, Fox JG. Novel intestinal Helicobacter species isolated from cotton-top tamarins (Saguinus oedipus) with chronic colitis. J Clin Microbiol. 1999; 37:146–151.
27. Laurent-Puig P, Olschwang S, Delattre O, et al. Survival and acquired genetic alterations in colorectal cancer. Gastroenterology. 1992; 102:1136–1141.
Article
28. Uchino S, Noguchi M, Ochiai A, Saito T, Kobayashi M, Hirohashi S. p53 mutation in gastric cancer: a genetic model for carcinogenesis is common to gastric and colorectal cancer. Int J Cancer. 1993; 54:759–764.
Article
29. Nakatsuru S, Yanagisawa A, Ichii S, et al. Somatic mutation of the APC gene in gastric cancer: frequent mutations in very well differentiated adenocarcinoma and signet-ring cell carcinoma. Hum Mol Genet. 1992; 1:559–563.
Article
30. Uchino S, Tsuda H, Noguchi M, et al. Frequent loss of heterozygosity at the DCC locus in gastric cancer. Cancer Res. 1992; 52:3099–3102.
31. Vogelstein B, Fearon ER, Hamilton SR, et al. Genetic alterations during colorectal-tumor development. N Engl J Med. 1988; 319:525–532.
Article
32. Ohtani H, Yashiro M, Onoda N, et al. Synchronous multiple primary gastrointestinal cancer exhibits frequent microsatellite instability. Int J Cancer. 2000; 86:678–683.
Article
33. Sanz-Ortega J, Sanz-Esponera J, Caldes T, Gomez de la Concha E, Sobel ME, Merino MJ. LOH at the APC/MCC gene (5Q21) in gastric cancer and preneoplastic lesions. Prognostic implications. Pathol Res Pract. 1996; 192:1206–1210.
34. Fogt F, Nikulasson ST, Holden JA, et al. Topoisomerase II alpha expression in normal, inflammatory, and neoplastic conditions of the gastric and colonic mucosa. Mod Pathol. 1997; 10:296–302.
35. Katz JP, Perreault N, Goldstein BG, et al. Loss of Klf4 in mice causes altered proliferation and differentiation and precancerous changes in the adult stomach. Gastroenterology. 2005; 128:935–945.
Article
36. Katz JP, Perreault N, Goldstein BG, et al. The zinc-finger transcription factor Klf4 is required for terminal differentiation of goblet cells in the colon. Development. 2002; 129:2619–2628.
Article
37. Konturek PC, Kania J, Burnat G, Hahn EG, Konturek SJ. Prostaglandins as mediators of COX-2 derived carcinogenesis in gastrointestinal tract. J Physiol Pharmacol. 2005; 56:57–73.
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