title: Sulindac induced regression of colorectal adenomas in familial adenomatous polyposis: evaluation of predictive factors.
abstract: BACKGROUND
  Sulindac, a non-steroidal anti-inflammatory drug, causes regression of colorectal adenomas in patients with familial adenomatous polyposis (FAP) but the response is variable. Specific clinical factors predictive of sulindac induced regression have not been studied.
  
  
  METHODS
  22 patients with FAP were given sulindac 150 mg orally twice a day. Polyp number and size were determined before treatment and at three months. The relation of nine clinical factors to polyp regression (per cent of baseline polyp number after treatment) was evaluated by univariate and multivariate analysis.
  
  
  RESULTS
  After three months of sulindac, polyp number had decreased to 45 per cent of baseline and polyp size to 50 per cent of baseline (p < 0.001 and p < 0.01, respectively). Univariate analysis showed greater polyp regression in older patients (p = 0.004), those with previous colectomy and ileorectal anastomosis (p = 0.001), and patients without identifiable mutation of the APC gene responsible for FAP (p = 0.05). With multivariate regression analysis, response to sulindac treatment was associated with previous subtotal colectomy.
  
  
  CONCLUSIONS
  Sulindac treatment seems effective in producing regression of colorectal adenomas of FAP patients with previous subtotal colectomy regardless of baseline polyp number and size. Changed sulindac metabolism, reduced area of the target mucosa, or changed epithelial characteristics after ileorectal anastomosis may explain these findings.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: F M
authors.initials: FM
authors.lastname: Giardiello
authors.forename: J A
authors.initials: JA
authors.lastname: Offerhaus
authors.forename: A C
authors.initials: AC
authors.lastname: Tersmette
authors.forename: L M
authors.initials: LM
authors.lastname: Hylind
authors.forename: A J
authors.initials: AJ
authors.lastname: Krush
authors.forename: J D
authors.initials: JD
authors.lastname: Brensinger
authors.forename: S V
authors.initials: SV
authors.lastname: Booker
authors.forename: S R
authors.initials: SR
authors.lastname: Hamilton
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000150:complications*; D018256:Adenomatous Polyps / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D016037:Single-Blind Method; D013467:Sulindac / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D013467:Sulindac