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Health Impact of Lactose Intolerance Tough to Assess

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Health Impact of Lactose Intolerance Tough to Assess 24 GASTROENTEROLOGY MARCH 15, 2010 • INTERNAL MEDICINE NEWS Fish Oil May Lower Rectal Polyp Burden in FAP BY DAVID MONAGAN The researchers randomized a total of rectal mucosa increased by 159% in the and director of endoscopy at Indiana 55 patients into two groups: EPA (28 pa- EPA group, compared with the placebo University Hospital. L ONDON — A small, randomized tri- tients who took a 500-mg capsule twice group. Dr. West acknowledged that this trial al suggests that fish oil given in tablet daily) or placebo (27 patients). All par- “Compared to placebo, EPA decreased was limited by its size and duration, and form as eicosapentaenoic acid may have ticipants first underwent sigmoidoscopy, the polyp burden in treated patients and thus could not show whether changes in chemopreventive effects, reducing the in which a focal area of rectum was tat- decreased the polyp size at 6 months. polyp burden following EPA could actu- number and size of precancerous rectal tooed for identification of baseline polyp The treatment was safe and well toler- ally reduce the likelihood of future colo- polyps in patients with familial adeno- number and size by endoscopists blind- ated, and may deserve serious consider- rectal cancer. Nor could it answer the matous polyposis. ed to each subject’s intended therapy. ation as an alternative therapy for FAP,” question of how long such therapy The theory that this approach may The patients also underwent rectal biop- Dr. West concluded. might need to be delivered to prevent have benefits in retarding cell prolifera- sies to determine the fatty acid content Dr. Douglas K. Rex commented in an colorectal cancer. tion has been tested in a number of oth- in their rectal tissue. interview that “sulindac remains the cor- But he noted that EPA supplementa- er settings, including prevention of pan- After 6 months, patients underwent a nerstone of chemoprevention in FAP. tion involves fewer side effects (and less creatic, kidney, and esophageal cancers. second blinded endoscopy, and the re- Celecoxib is an alternative when there is expense) than was seen in trials of the But data on free fatty acid supplementa- sults “were highly statistically signifi- low cardiac risk and high risk of GI tox- COX-2 inhibitor celecoxib, which has tion in the setting of familial adenoma- cant” in favor of EPA supplementation. icity from NSAIDs. Fish oil is attractive been associated with adverse inflamma- tous polyposis (FAP) have generally been EPA patients had a 12.6% reduction of because of its low risk profile, and it tory and cardiovascular effects. “Free fat- confined to animal studies and anecdo- their polyp burden in the targeted area. could be offered to FAP patients for this ty acid has the potential to serve as an im- tal patient reports. In contrast, placebo patients showed a reason pending the results of additional portant therapeutic option if these The new study was reported by Dr. 22.4% increase in their polyp count. studies of efficacy.” results can be borne out by larger trials,” N.J. West of St. Mark’s Hospital, Harrow, The difference between the groups “Endoscopists should remember that he observed. ■ England, at the 13th World Congress of amounted to an overall 24% relative re- no chemopreventive treatment replaces Gastroenterology. The goal was to ex- tardation in polyp growth with EPA endoscopic monitoring in FAP, and no Disclosures: The study is an offshoot of a amine whether eicosapentaenoic acid supplementation. Moreover, the blind- chemopreventive therapy clearly pre- British polyp registry that was developed, (EPA) supplementation reduced polyp ed endoscopists found a 30% smaller vents cancer in FAP,” cautioned Dr. Rex, with support from the National Cancer burden in the setting of FAP, as assessed mean polyp size in patients receiving who is distinguished professor of medi- Institute, Pfizer, and Ilex Oncology, to by blinded outside endoscopists. the fish oil. In addition, EPA levels in the cine at Indiana University, Indianapolis, conduct clinical trials of agents of interest. Health Impact of Lactose Intestinal Metaplasia Tied to Intolerance Tough to Assess High Risk of Gastric Cancer BY JEFF EVANS ter a blinded, single-dose challenge of in- BY SHERRY BOSCHERT suggested. He acknowledged the cost gested lactose but not after ingestion of an of increased surveillance, but noted B ETHESDA, MD. — The health effects indistinguishable placebo. None of the S AN D IEGO — The risk for gastric that the gastric cancer rate in patients of lactose intolerance in people who avoid studies in the panel’s review used this de- cancer was more than 200 times high- with GIM is similar to that in patients dairy foods have not been adequately stud- finition or evaluated a representative sam- er in patients with gastric intestinal with severe dysplasia. “If patients have ied to determine if there are nutritional ple of the U.S. population. metaplasia on initial or repeat upper severe dysplasia on biopsy, we will deficiencies or long-term effects on bone Many studies reviewed by the panel did endoscopy, compared with the con- bring these patients back for follow-up. and cardiovascular health, according to not verify if gastrointestinal symptoms re- trol population, in a retrospective So, if we’re seeing similar rates of pro- findings from a panel of experts assembled sulted from lactose malabsorption (which study of 11,600 male veterans. gression to cancer from GIM, these pa- by the National Institutes of Health. may or may not be symptomatic) in peo- Of the cohort of 354 veterans, 3% tients probably should be followed up.” In a draft “state ple who have lost were diagnosed with gastric intestinal He and his associates were sur- of the science” A substantial proportion of most or all lactase metaplasia (GIM) over a 19-year peri- prised to find that having a history of statement, the 14- expression in their od; the researchers compared their Helicobacter pylori infection did not member panel people who have little or no small intestine. records with those of 355 randomly se- significantly influence pathology re- was not able to es- lactase activity do not have These so-called lected patients seen at the GI clinic of sults. He attributed that to early in- timate the preva- lactase nonpersis- the Brooklyn campus of the Veterans tervention (that is, treatment that was lence of lactose in- lactose intolerance and may be ters form the ma- Affairs New York Harbor Healthcare initiated whenever H. pylori was di- tolerance from a missing out on the benefits of jority of all people System. agnosed by histology). systematic review worldwide. Among veterans with GIM, 6% (21 Patients with GIM were more like- of 54 studies but nutrients in dairy foods. Evidence sug- patients) were diagnosed with gastric ly to be 70-90 years old, whereas those concluded that a gests that adults cancer, a rate 200-fold higher than the without GIM were more likely to be substantial proportion of people who have and adolescents who have been diagnosed rate in the control group, Dr. Naveen aged 50-70 years. About half of pa- little or no lactase activity do not have lac- with lactose malabsorption could ingest at Anand and his associates reported at tients in the GIM and control groups tose intolerance and may be missing out least 12 g of lactose (equivalent to the lac- the annual meeting of the American were black and half were white, and on the health benefits of nutrients in dairy tose content of 1 cup of milk) with no or College of Gastroenterology. there were few veterans of other races foods, primarily calcium and vitamin D. minor symptoms, the panel found. Half of the cancer diagnoses were or ethnicities. The mean age in blacks “Particularly in children and adoles- The panel advised creating individual- made on the initial endoscopy, and was significantly older than in whites cents, it’s very difficult for them to receive ized strategies for patients with real or per- half were made on follow-up en- (75 vs. 71 years), and blacks account- the required amounts of calcium and vit- ceived lactose intolerance, such as eating doscopy, said Dr. Anand, a chief resi- ed for 67% of patients who developed amin D if they avoid dairy products com- small amounts of dairy foods with other dent at the State University of New gastric cancer, Dr. Anand said. pletely,” panel chairperson Dr. Frederick J. meals and spreading dairy intake through- York Downstate Medical Center, “We believe there is a long lead time Suchy said in a press briefing. “Sometimes out the day. Calcium-fortified soy or rice Brooklyn. Repeat endoscopies were between the premalignant lesion and parents perceive themselves as being lac- drinks, fruit juices, soy products, dried performed on 53% of the cohort (in- intestinal metaplasia and intestinal- tose intolerant when they’re not and then beans, and leafy greens are good nondairy cluding 11% who underwent four or type gastric carcinoma, similar to what impose that condition on their child with- sources of calcium, the panel noted. ■ more endoscopies). we see in colon cancer and cervical out any testing,” said Dr. Suchy, professor Patients with GIM—especially pa- cancer, which gives us an opportuni- of pediatrics at Kravis Children’s Hospital Disclosures: None of the panelists reported tients in these higher-risk subgroups— ty for possible surveillance and even at Mount Sinai Hospital, New York. relevant conflicts of interest. should undergo regular endoscopic possible intervention,” he said. ■ The panel defined lactose intolerance as surveillance with careful histologic di- onset of gastrointestinal symptoms in an A copy of the draft statement is at http:// agnosis of GIM based on biopsies at Disclosures: The investigators reported individual with lactose malabsorption, af- consensus.nih.gov/2010/lactose.htm.
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