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Biomarkers for IBD-Related Colon Cancer: CCFA Researchers Seek Better Ways to Detect Risk and Prevent Disease. Take Charge. p. 32-35. Winter 2006.

One of the complications of inflammatory bowel disease (IBD, including Crohn's disease and ulcerative colitis) is an increased risk for colon cancer, a risk that rises even more after people have had colitis or Crohn's of the colon for more than 8 to 10 years. This article discusses the biomarkers used to detect IBD-related colon cancer. Gastroenterologists urge people with IBD to have a colonoscopy every one to two years after they have had IBD for more than 8 years. The author considers the increased cancer risk (which actually applies to a minority of IBD patients, approximately 10 percent) and diagnostic or screening strategies that can distinguish between inflammatory changes in the colon and precancerous ones. The author outlines the problems with colonoscopy in this patient population and makes the case for a quick, non-invasive test for colon cancer based on a biomarker, comparable to the Prostate Specific Antigen (PSA) which is used to screen for prostate cancer. The Crohn's and Colitis Foundation of America (CCFA) is currently supporting three research projects concerning the identification and testing of genetic markers for colon cancer. The author concludes that soon some of the genetic and other tests under study will be moved from the lab to clinical use, where they will complement colonoscopy in screening people with IBD for colon cancer. The article includes quotes from and photographs from three researchers in the area of biomarkers. 3 figures.

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Helicobacter Pylori: What Do We Still Need to Know?. Journal of Clinical Gastroenterology. 40(1): 15-19. January 2006.

Helicobacter pylori is a common gastric infection that causes serious complications in a minority of individuals. Although a great deal is known about this disease, there remain many unanswered questions. This article addresses these gaps in knowledge and the author hypothesizes that a number of the unanswered questions are related to a putative increase in gastric acid secretion that may have taken place during the past 200 years. The uncertainties addresses include why the prevalence of the disease is falling within the developed population, the interrelationship between H. pylori infection and gastroesophageal reflux disease, the differences in the international incidence of gastric cancer, and the changing complications of H. pylori over time. With the improving socioeconomic conditions at the end of the 19th century following the Industrial Revolution and the beginning of the 20th century with better nutrition and stature, acid secretion may have increased and H. pylori gastritis may have become more antral predominant. This is the phenotype of duodenal ulceration that also protects against gastric cancer. By the middle of the 20th century, therefore, gastric cancer was declining, but duodenal ulcer peaked. At this time, the prevalence of H. pylori began fall, either as a result of better hygiene and nutrition or possibly because of increasing acid secretion. The author notes that these speculations are not based on objective scientific evidence but rather are an interpretation of circumstantial evidence that fits with the changing patterns of disease seen over time. 26 references.

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Irritable Bowel Syndrome in the United States: Prevalence, Symptom Patterns and Impact. Alimentary Pharmacology and Therapeutics. 21(11): 1365-1375. June 2005.

Irritable bowel syndrome (IBS) is a chronic, episodic functional gastrointestinal disorder characterized by abdominal pain, discomfort, and altered bowel habits, including constipation, diarrhea, or a combination thereof. This article reports on the prevalence, symptom patterns, and impact of IBS in the United States. The authors stress that the impact of IBS is underestimated and poorly quantified, as clinicians may see only a minority of people with this condition. The authors used a two-phase community survey with quota sampling and random-digit telephone dialing (a screening interview) to identify individuals with medically diagnosed IBS or individuals not formally identified but who fulfilled IBS diagnostic criteria (Manning, Rome I, or Rome II). The authors conducted in-depth, follow-up interviews in which information on IBS symptoms, general health status, lifestyle, and impact of symptoms in the individuals’ lives was collected. Data was also collected for healthy controls identified in the screening interviews. Results showed that the total prevalence of IBS in 5,009 screening interviews was 14.1 percent (medically diagnosed, 3.3 percent; undiagnosed, but meeting IBS criteria, 10.8 percent). Abdominal pain or discomfort was the most common symptom prompting consultation. Most patients (75 percent medically diagnosed; 63 percent undiagnosed) reported alternating constipation and diarrhea. IBS patients had more days off work, days in bed, and reduced activities compared to the control group. The authors conclude that the majority of people with IBS in the United States are undiagnosed.

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