Aspirina en la prevención del cáncer colorrectal / Aspirin in the prevention of colorectal cancer

Los adenomas colorrectales son precursores de la mayoría de los cánceres colorrectales (CCR) por lo que constituyen una diana importante en la quimioprevención. Se ha comprobado que los niveles de ciclooxigenasa 2 (COX-2) se encuentran elevados en la mayoría de las neoplasias y adenomas colónicos. Dicha enzima se ha asociado con la carcinogénesis al aumentar los valores de prostaglandina, que a su vez favorece la angiogénesis, la proliferación y migración celular y aporta resistencia en la apoptosis. Estas evidencias apoyan el uso del ácido acetilsalicílico (AAS) o aspirina, inhibidor de COX-2, en la prevención del desarrollo de CCR. Los estudios de casos y controles y cohortes han demostrado que el uso regular de AAS reduce casi a la mitad el riesgo de CCR respecto a los no consumidores. Sin embargo, los resultados obtenidos en los ensayos clínicos discrepan, objetivando una disminución aproximada del riesgo de recurrencia de adenoma que ronda en torno al 17%. Hasta la fecha, aunque el AAS haya demostrado su eficacia en la prevención de adenoma y cáncer colorrectal, con los datos que disponemos se desconoce la dosis y duración necesaria para obtener este beneficio. Probablemente cuanto más prolongado sea el tratamiento, incluso durante más de 10 años y posiblemente a dosis mayores, la reducción del riesgo sea mayor. Finalmente, el AAS no está exento de riesgos y antes de incluirlo en la estrategia preventiva se debería sopesar el efecto que tiene sobre la incidencia de CCR con los riesgos y beneficios de su uso prolongado (AU)

Colorectal adenomas are precursors of most colorectal cancers and are consequently a surrogate endpoint for assessing the efficacy of chemopreventive agents. Cyclooxygenase-2 (COX-2) levels have been found to be increased in a significant number of colorectal carcinomas and adenomas. COX-2 overexpression is linked to carcinogenesis due to increased production of prostaglandins, which seem to play an important role in angiogenesis, cell proliferation and migration, as well as in apoptosis. These data support the use of acetylsalicylic acid (AAS) or aspirin, a COX-2 inhibitor, as an effective agent in colorectal cancer prevention. Several cohort and case control studies have shown that regular use of aspirin reduces the risk of colorectal cancer by approximately 50%. However, randomized controlled trials of aspirin report discrepant results, although there is an decrease in the relative risk of adenoma recurrence of approximately 17%. To date, although there is compelling evidence that the use of aspirin protects against adenoma and colorectal cancer, the optimal dose and duration of aspirin required to obtain this effect remain to be defined. Probably, the longer the treatment duration – even for more than 10years - and possibly with higher doses, the greater the protective effects of aspirin. Finally, these benefits need to be considered in the context of all of the health effects of prolonged aspirin use, both positive and negative (AU)

[Aspirin in the prevention of colorectal cancer]. / Aspirina en la prevención del cáncer colorrectal.

Colorectal adenomas are precursors of most colorectal cancers and are consequently a surrogate endpoint for assessing the efficacy of chemopreventive agents. Cyclooxygenase-2 (COX-2) levels have been found to be increased in a significant number of colorectal carcinomas and adenomas. COX-2 overexpression is linked to carcinogenesis due to increased production of prostaglandins, which seem to play an important role in angiogenesis, cell proliferation and migration, as well as in apoptosis. These data support the use of acetylsalicylic acid (AAS) or aspirin, a COX-2 inhibitor, as an effective agent in colorectal cancer prevention. Several cohort and case control studies have shown that regular use of aspirin reduces the risk of colorectal cancer by approximately 50%. However, randomized controlled trials of aspirin report discrepant results, although there is an decrease in the relative risk of adenoma recurrence of approximately 17%. To date, although there is compelling evidence that the use of aspirin protects against adenoma and colorectal cancer, the optimal dose and duration of aspirin required to obtain this effect remain to be defined. Probably, the longer the treatment duration--even for more than 10 years--and possibly with higher doses, the greater the protective effects of aspirin. Finally, these benefits need to be considered in the context of all of the health effects of prolonged aspirin use, both positive and negative.

[Tonsillar hypertrophy and mesenteric adenopathies as the main manifestations in a patient with Whipple's disease]. / Hipertrofia amigdalar y adenopatías mesentéricas como manifestaciones predominantes en un paciente con enfermedad de Whipple.

Whipple's disease is an infrequent chronic infection caused by Tropheryma whipplei, identified in 1992. Intestinal, articular, central nervous system and cardiac involvement is common. The presence of abdominal adenopathies, especially mesenteric adenopathies, without peripheral adenopathies or gastrointestinal, articular, neurological or cardiac symptoms is rare. We present the case of a male patient with tonsillar hypertrophy, mesenteric adenopathies, fever and constitutional syndrome, leading to suspicion of lymphoma. Biopsy findings of the lingual tonsil and mesenteric adenopathies were compatible with Whipple's disease. The diagnosis was confirmed by blood polymerase chain reaction.

Hipertrofia amigdalar y adenopatías mesentéricas como manifestaciones predominantes en un paciente con enfermedad de Whipple / Tonsillar hypertrophy and mesenteric adenopathies as the main manifestations in a patient with Whipple’s disease

La enfermedad de Whipple es una infección crónica poco habitual, cuyo germen causal, Tropheryma whipplei, fue identificado en 1992. En esta entidad es frecuente la participación del intestino, las articulaciones, el sistema nervioso central y el corazón. La presencia de adenopatías abdominales, sobre todo mesentéricas, sin adenopatías periféricas ni síntomas digestivos, articulares, neurológicos o cardíacos, es rara. Se presenta el caso de un paciente con hipertrofia amigdalar, adenopatías mesentéricas, fiebre y síndrome constitucional, en el que se sospechó un linfoma. La biopsia de la amígdala lingual y las adenopatías mesentéricas fueron compatibles con enfermedad de Whipple, diagnóstico que se confirmó mediante reacción en cadena de la polimerasa en sangre

Whipple's disease is an infrequent chronic infection caused by Tropheryma whipplei, identified in 1992. Intestinal, articular, central nervous system and cardiac involvement is common. The presence of abdominal adenopathies, especially mesenteric adenopathies, without peripheral adenopathies or gastrointestinal, articular, neurological or cardiac symptoms is rare. We present the case of a male patient with tonsillar hypertrophy, mesenteric adenopathies, fever and constitutional syndrome, leading to suspicion of lymphoma. Biopsy findings of the lingual tonsil and mesenteric adenopathies were compatible with Whipple's disease. The diagnosis was confirmed by blood polymerase chain reaction (AU)