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Prognosis in Patients with Melanosis Coli; a Prospective Study

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Prognosis in Patients with Melanosis Coli; a Prospective Study Original Investigation/Orijinal Araştırma İstanbul Med J 2019; 20(3): 198-201 DO I: 10.4274/imj.galenos.2018.36043 Prognosis in Patients with Melanosis Coli; A Prospective Study Melanozis Kolili Hastalarda Prognoz; Prospektif Bir Çalışma Aylin Hande Gökçe1, Feridun Suat Gökçe2 1İstanbul Medicine Hospital, Clinic of General Surgery, İstanbul, Turkey 2Istanbul Balıklı Rum Hospital, Clinic of General Surgery, İstanbul, Turkey ABSTRACT ÖZ Introduction: Melanosis coli is a benign lesion associated with Amaç: Melanozis koli antrakinon içeren laksatiflerin fazla the overuse of laxatives containing anthraquinone. The aim kullanımına bağlı olarak ortaya çıkan benign bir lezyon olarak of this study is to determine whether melanosis recovers after düşünülür. Çalışmanın amacı melanozis kolili hastaların the discontinuation of laxatives and whether this condition is laksatiflerle ilişkisi, laksatif bırakılınca iyileşip iyileşmediği, associated with a higher incidence of colon polyps or cancer normal popülasyona göre kolon polibi ve kolon kanseri ile compared to the general population. ilişkili olup olmadığını saptamaktır. Methods: Patients with confirmed melanosis coli were Yöntemler: Kolonoskopi ile melanozis koli saptanan olgulara performed a repeat colonoscopy and biopsy 2 years later and 2 yıl sonra kontrol kolonoskopisi yapıldı ve histopatoloji their histopathological examination results were compared. sonuçları karşılaştırıldı. Olguların yaşları, cinsiyetleri, Data on age, sex, the use of any medicinal laxative or herbals, laksatif ilaç veya bitki çayı kullanıp kullanmadığı, laksatif the presence of findings after the discontinuation of laxatives, kullananların bıraktıktan sonra bulgularının devam edip constipation, colon polyp, and the relationship with colon etmediği, konstipasyon, kolon polibi ve kolon kanseriyle ilişki cancer were examined. The similarity of segments and their olup olmadığı araştırıldı. Melanozis koli saptanan olguların relationships in the first and control colonoscopies were ilk ve kontrol kolonoskopilerindeki segmentlerin benzerliği ve investigated in cases detected to have melanosis coli. ilişkisi araştırıldı. Results: All 104 patients included in the study were suffering Bulgular: Çalışmaya alınan 104 olgunun hepsinde konstipasyon from constipation. While the number of patients using mevcuttu. Laksatif ilaç veya çay kullanan olgu sayısı ilk başta laxatives or herbal tea was initially 96, it was 24 at the time of 96 idi, kontrolde ise 24 hasta laksatif ilaç veya çay kullanmaya follow-up colonoscopy. Although the majority of subjects had devam ediyordu. Olguların büyük çoğunluğu laksatif discontinued laxatives, histological findings of melanosis coli kullanımını bıraktığı halde 104 olgunun 88’inde histopatolojik persisted in 88 of 104 subjects. Mostly descending colon and olarak melanozis koli bulguları devam etmekteydi. rectum were involved. Çalışmamızda en sık sol kolon ve rektum tutulmuştu. Conclusion: It is thought that the findings of melanosis coli Sonuç: Melanosis coli bulgularının laksatif ilaç veya çayların disappear in about 6 months following the discontinuation of kullanımı bırakıldıktan yaklaşık 6 ay sonra düzeldiği laxative drugs and herbal teas. However, it was detected in our düşünülmektedir. Fakat bizim serimizde 2 yıl sonraki takipte series that while the macroscopic findings were mostly healed bile büyük çoğunluğunda makroskopik bulgular düzeldiği even in the follow-up after two years, microscopic findings of halde mikroskobik olarak melanosis koli bulgularının devam melanosis coli continued to remain. No relationship was found ettiği saptandı. Çalışmada melanosis koliyle kolon kanseri ve between melanosis coli and the development of colon cancer kolon polibi arasında bir ilişki saptanmadı. Melanosis kolinin and polyp. In the present study, it was aimed to emphasize kronikleşmesinin ve kolon kanserine yatkınlık oluşturup that melanosis coli’s becoming chronic and its creating a oluşturmamasının daha uzun takiplerle araştırılması predisposition to colon cancer should be investigated with gerektiğini ve bazı bitki çaylarının kolon mukozasına uzun longer follow-ups and some herbal teas may cause a long-term süreli değişikliğe yol açabileceğini vurgulamak istedik. change in the colon mucosa. Anahtar Kelimeler: Melanozis koli, konstipasyon, kolonoskopi, Keywords: Melanosis coli, constipation, colonoscopy, hiperpigmentasyon hyperpigmentation Address for Correspondence/Yazışma Adresi: Aylin Hande Gökçe MD, İstanbul Medicine Hospital, Clinic of General Received/Geliş Tarihi: 26.11.2018 Surgery, İstanbul, Turkey Accepted/Kabul Tarihi: 26.12.2018 Phone: +90 505 250 20 79 E-mail: [email protected] ORCID ID: orcid.org/0000-0003-1908-2889 Cite this article as/Atıf: Gökçe AH, Gökçe FS. Prognosis in Patients with Melanosis Coli; A Prospective Study. İstanbul Med J 2019; 20(3): 198-201. ©Copyright 2019 by the İstanbul Training and Research Hospital/İstanbul Medical Journal published by Galenos Publishing House. ©Telif Hakkı 2019 İstanbul Eğitim ve Araştırma Hastanesi/İstanbul Tıp Dergisi, Galenos Yayınevi tarafından basılmıştır. 198 Gökçe and Gökçe. Melanosis Coli Introduction whereas categorical variables were shown as percentages. A p value less Melanosis coli is a condition characterized by the dark pigmentation of than 0.05 indicated statistical significance. the mucosal lining of the large intestine, resulting from chronic use of laxatives containing anthraquinone. This condition may occur within a Results few months following the use of laxatives and may gradually disappear During the above-mentioned period, a total of 3416 colonoscopy within a few months following the discontinuation of laxatives (1,2). procedures were performed and 112 patients were diagnosed with Overuse of laxatives, notably the ones containing anthraquinone melanosis coli (Figures 1, 2). Eight of these patients died of unrelated laxative, and overuse of herbal teas, including aloe vera, meadow causes during the follow-up, therefore, a follow-up colonoscopy saffron, cockspur-hawthorn, and buckthorn, have been implicated in procedure could not be performed. Seventy-two of these patients were the development of melanosis coli. The mechanism of action of this female (64.3%), and 40 patients were male (35.7%). The age range of group of drugs and herbal teas is to increase the accumulation of study patients varied from 29 to 82 years (the mean age 56.1±17.8 fluid and electrolytes in the distal ileum. Herbal laxatives containing years). All patients were experiencing constipation. Benign colon polyps anthraquinone cause a damage in the epithelial cells and lead to were removed in 16 subjects (14.3%) during the initial colonoscopy. The changes in absorption, secretion and motility (3,4). descending colon was affected by melanosis in 64 patients (57.1%) while ascending colon involvement was detected in 16 patients (14.3%) and The pigment deposits in melanosis coli consist of hemosiderin, lipofuscin, melanosis affected the colon in whole in 32 patients (28.6%) (Table 1). lipofuscin-like pigment and ferrous sulfate rather than melanin (3,4). The diagnosis of melanosis coli is made based on the histological examination of biopsy specimens collected from suspicious segments during colonoscopy or biopsy specimens taken for any other reasons (Figure 1). Pigment deposits are observed in macrophages located in lamina propria of the large intestine while pigments are unequally distributed across different segments of the large intestine and melanosis affects more frequently the cecum and proximal colon (5,6). Although melanosis coli has been considered as a benign condition, it remains unknown whether melanosis increases the risk for colorectal cancer. Melanosis begins 4 months after the initiation of anthraquinone laxatives. Melanosis has been usually reported to be a benign condition and resolves within one year after the discontinuation of laxatives (4,7). In this study, we aimed to assess follow-up clinical and colonoscopy findings in comparison with initial findings in patients diagnosed with melanosis coli. Figure 1. Microscopic appearance of melanosis coli with hematoxylin eosin enlargement of 100 dyes Methods This study was designed to prospectively assess patients diagnosed with melanosis coli following the histopathological examination of biopsy specimens taken from the areas of macroscopic hyperpigmentation which were detected during colonoscopy that was performed in our clinic. Ethics approval for this study was obtained from the İstanbul Training and Research Hospital Ethics Committee (KAEK-50-1267). All participants provided their informed consent. Patients who had bowel movements 3 times or less per week were considered as constipated. Data on the age and sex were collected and study subjects were asked if they were using any medicinal laxative or herbal teas and whether they had a history of constipation or colon polyps or colon cancer and they were screened for such lesions via colonoscopy. Colonoscopy findings of these patients were assessed to detect whether colon segments found to be involved in melanosis during the follow-up colonoscopy were similar or connected to those detected during the initial colonoscopy. Statistical Analysis Data were analyzed using w-2 test in SPSS version 16 software. Figure 2. Macroscopic appearance of melanosis coli during colonoscopy Continuous variables were presented as mean ± standard deviation, 199 İstanbul Med J 2019; 20(3): 198-201 study, the descending colon and rectum were predominantly
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