title: Eviendep® reduces number and size of duodenal polyps in familial adenomatous polyposis patients with ileal pouch-anal anastomosis.
abstract: OBJECTIVE
  To evaluate if 3 mo oral supplementation with Eviendep® was able to reduce the number of duodenal polyps in familial adenomatous polyposis (FAP) patients with ileal pouch-anal anastomosis (IPAA).
  
  
  METHODS
  Eleven FAP patients with IPAA and duodenal polyps were enrolled. They underwent upper gastrointestinal (GI) endoscopy at the baseline and after 3 mo of treatment. Each patient received 5 mg Eviendep twice a day, at breakfast and dinner time, for 3 mo. Two endoscopists evaluated in a blinded manner the number and size of duodenal polyps. Upper GI endoscopies with biopsies were performed at the baseline (T0) with the assessment of the Spigelman score. Polyps > 10 mm were removed during endoscopy and at the end of the procedure a new Spigelman score was determined (T1). The procedure was repeated 3 mo after the baseline (T2). Four photograms were examined for each patient, at T1 and T2. The examined area was divided into 3 segments: duodenal bulb, second and third portion duodenum. Biopsy specimens were taken from all polyps > 10 mm and from all suspicious ones, defined by the presence of a central depression, irregular surface, or irregular vascular pattern. Histology was classified according to the updated Vienna criteria.
  
  
  RESULTS
  At baseline the mean number of duodenal detected polyps was 27.7 and mean sizes were 15.8 mm; the mean Spigelman score was 7.1. After polypectomy the mean number of duodenal detected polyps was 25.7 and mean sizes were 7.6 mm; the mean Spigelman score was 6.4. After 3 mo of Eviendep bid, all patients showed a reduction of number and size of duodenal polyps. The mean number of duodenal polyps was 8 (P = 0.021) and mean size was 4.4 mm; the mean Spigelman score was 6.6. Interrater agreement was measured. Lesions > 1 cm found a very good degree of concordance (kappa 0.851) and a good concordance was as well encountered for smaller lesions (kappa 0.641).
  
  
  CONCLUSIONS
  Our study demonstrated that short-term (90 d) supplementation with Eviendep® in FAP patients with IPAA and with recurrent adenomas in the duodenal mucosa, resulted effective in reducing polyps number of 32% and size of 51%.
authors.affiliation: Carlo Calabrese, Chiara Praticò, Andrea Calafiore, Maurizio Coscia, Lorenzo Gentilini, Gilberto Poggioli, Paolo Gionchetti, Massimo Campieri, Fernando Rizzello, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), University of Bologna, 40138 Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Calabrese
authors.forename: Chiara
authors.initials: C
authors.lastname: Praticò
authors.forename: Andrea
authors.initials: A
authors.lastname: Calafiore
authors.forename: Maurizio
authors.initials: M
authors.lastname: Coscia
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gentilini
authors.forename: Gilberto
authors.initials: G
authors.lastname: Poggioli
authors.forename: Paolo
authors.initials: P
authors.lastname: Gionchetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Campieri
authors.forename: Fernando
authors.initials: F
authors.lastname: Rizzello
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000178:diet therapy / Q000188:drug therapy* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D039021:Colonic Pouches; D004043:Dietary Fiber / Q000627:therapeutic use; D004378:Duodenal Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000517:prevention & control*; D008297:Male; D048789:Phytoestrogens / Q000627:therapeutic use*; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D004043:Dietary Fiber; D048789:Phytoestrogens; D010936:Plant Extracts
keywords: Duodenal polyps; Eviendep; Familial adenomatous polyposis; Ileal pouch-anal anastomosis
references.citation: N Engl J Med. 1993 May 6;328(18):1313-6
references.pmid: 8385741
references.citation: J Gastrointest Surg. 2002 Sep-Oct;6(5):671-5
references.pmid: 12399055
references.citation: Cancer Res. 1984 Jun;44(6):2410-5
references.pmid: 6722782
references.citation: Cancer Res. 2000 Jan 15;60(2):245-8
references.pmid: 10667568
references.citation: Cell. 1991 Aug 9;66(3):589-600
references.pmid: 1651174
references.citation: Fam Cancer. 2014 Mar;13(1):23-8
references.pmid: 23743563
references.citation: Curr Med Chem. 2000 May;7(5):561-76
references.pmid: 10702625
references.citation: World J Gastroenterol. 2013 Jul 21;19(27):4325-33
references.pmid: 23885143
references.citation: N Engl J Med. 1988 Sep 1;319(9):525-32
references.pmid: 2841597
references.citation: N Engl J Med. 2000 Jun 29;342(26):1946-52
references.pmid: 10874062
references.citation: Cancer Res. 1984 Oct;44(10):4670-4
references.pmid: 6467220
references.citation: Gut. 2002 May;50(5):636-41
references.pmid: 11950808
references.citation: N Engl J Med. 2006 Aug 31;355(9):885-95
references.pmid: 16943401
references.citation: Cancer Lett. 2001 Jul 10;168(1):65-70
references.pmid: 11368879
references.citation: Endoscopy. 2007 Jan;39(1):52-7
references.pmid: 17252461
references.citation: Gastroenterology. 2001 Nov;121(5):1127-35
references.pmid: 11677205
references.citation: Lancet. 1989 Sep 30;2(8666):783-5
references.pmid: 2571019
references.citation: Clin Gastroenterol Hepatol. 2009 Jun;7(6):659-63
references.pmid: 19281862
references.citation: Carcinogenesis. 2005 Mar;26(3):587-95
references.pmid: 15579483
references.citation: Dig Dis Sci. 1994 Sep;39(9):2038-42
references.pmid: 8082515
references.citation: Cancer Res. 2001 Jan 15;61(2):632-40
references.pmid: 11212261
references.citation: Lancet Oncol. 2008 Apr;9(4):385-91
references.pmid: 18374292
references.citation: J Natl Cancer Inst. 2001 Dec 5;93(23):1799-805
references.pmid: 11734596
references.citation: Endoscopy. 2008 Sep;40(9):773-4
references.pmid: 18716983
references.citation: Best Pract Res Clin Gastroenterol. 2011 Aug;25(4-5):607-22
references.pmid: 22122775
references.citation: J Clin Oncol. 2011 Apr 1;29(10):1382-91
references.pmid: 21220596
references.citation: Nature. 1987 Aug 13-19;328(6131):614-6
references.pmid: 3039373
references.citation: Gastroenterology. 1987 Dec;93(6):1301-6
references.pmid: 3678749
references.citation: Gastrointest Endosc. 2008 Jan;67(1):61-7
references.pmid: 18155426
references.citation: J Endocrinol. 1999 Dec;163(3):379-83
references.pmid: 10588810
references.citation: Curr Drug Targets Immune Endocr Metabol Disord. 2001 May;1(1):1-12
references.pmid: 12476778
references.citation: Annu Rev Pharmacol Toxicol. 1996;36:203-32
references.pmid: 8725388
references.citation: Colorectal Dis. 2012 Aug;14(8):947-52
references.pmid: 21973191
references.citation: Gut. 2002 Jun;50(6):857-60
references.pmid: 12010890
references.citation: J Steroid Biochem Mol Biol. 2003 Aug;86(2):179-88
references.pmid: 14568570
references.citation: Gastrointest Endosc. 1999 Mar;49(3 Pt 1):358-64
references.pmid: 10049420
references.citation: Cancer Res. 2001 Mar 15;61(6):2547-51
references.pmid: 11289129
references.citation: Carcinogenesis. 2010 Feb;31(2):269-74
references.pmid: 19945967
references.citation: Cancer Epidemiol Biomarkers Prev. 1998 Apr;7(4):329-33
references.pmid: 9568789
references.citation: Dis Colon Rectum. 1993 Jul;36(7):662-7
references.pmid: 8348850
references.citation: Science. 1991 Aug 9;253(5020):661-5
references.pmid: 1651562
references.citation: Nat Rev Gastroenterol Hepatol. 2011 Oct 18;8(12):686-700
references.pmid: 22009203