Rehana Begum

Folate Status and Risk of Colorectal Polyps in African Americans

Dietary folate status appears to influence risk for colorectal cancer possibly by alterations in DNA methylation and nucleotide precursor pools. Polymorphisms (677C→T and 1298A→C) in methylenetetrahydrofolate reductase (MTHFR), a key enzyme in folate metabolism, determines enzyme activity. The frequency of polymorphisms in the gene varies extensively in different populations. We sought to determine the association between folate status, folate metabolism, DNA methylation, tobacco, alcohol consumption, and the risk of colorectal adenomas in African Americans. Among 58 patients who underwent a clinically indicated colonoscopy, 23 patients with histology confirmed colorectal polyps and 35 patients without were recruited for a case-control study. Blood samples were collected from fasting patients for determination of serum and red blood cell (RBC) folate, homocysteine, vitamin B12, and methylation status. Polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP) technique was performed to identify the MTHFR 677 C→T polymorphism and specific PCR was used to analyze adenomatous polyposis coli (APC) gene-promoter sequence methylation. Among 23 cases, 49 polyps (adenomatous, n = 41 and hyperplastic, n= 8) were identified. Twenty-eight (57%) of the polyps were on the left side and 21 (42%) were on the right side of the colon. There was no association between the presence of colon polyps and levels of folate (serum, RBC), vitamin B12, or homocysteine. Forty-eight individuals (84%) were homozygous for 677 CC. Of these individuals, 18 (37.5%) had ≥1 colorectal polyps, whereas 30 (62.5%) had no polyps. Nine individuals were heterozygous for 677 CT, and 4 (44%) of these individuals had colon polyps. Eighty-eight percent of the APC gene-promoter sequences tested using peripheral blood DNA from patients were unmethylated. Among the individuals who showed APC methylation, 66% had polyps; 33% were polyp free using their blood DNA. There was highly significant association between smoking and alcohol consumption with the presence of a colon polyp (P= .0006 and P= .05, respectively). In conclusion, the lack of the 677 TT may be a significant risk factor for colon neoplasm in the African-American population. Smoking and alcohol consumption were found to be risk factors for colon polyps. APC gene-promoter sequence methylation found in peripheral blood may be an indicator of risk for polyp formation and an important screening tool.

BMI and the risk of colorectal adenoma in African-Americans.

Obesity is associated with the activation of the molecular pathways that increase the risk of colorectal cancer. Increasing body mass index may accelerate the development of adenomatous polyps, the antecedent lesion of colorectal cancer. The aim of this study was to assess the BMI effect on the risk of colonic polyp and adenoma in African‐American.

Association between Diverticular Disease and Pre-Neoplastic Colorectal Lesions in an Urban African-American Population.

Background: It is unclear whether there is a shared pathway in the development of diverticular disease (DD) and potentially neoplastic colorectal lesions since both diseases are found in similar age groups and populations. Aim: To determine the association between DD and colorectal pre-neoplastic lesions in an African-American urban population. Methods: Data from 1986 patients who underwent colonoscopy at the Howard University Hospital from January 2012 through December 2012 were analyzed for this study. The presence of diverticula and polyps was recorded using colonoscopy reports. Polyps were further classified into adenoma or hyperplastic polyp based on histopathology reports. Multiple logistic regression was done to analyze the association between DD and colonic lesions. Results: Of the 1986 study subjects, 1,119 (56%) were females, 35% had DD and 56% had at least one polyp. There was a higher prevalence of polyps (70 vs. 49%; OR = 2.3; 95% CI: 1.9-2.8) and adenoma (43 vs. 25%; OR = 2.0; 95% CI: 1.7-2.5) in the diverticular vs. non-diverticula patients. Among patients who underwent screening colonoscopy, the presence of diverticulosis was associated with increased odds of associated polyps (OR = 9.9; 95% CI: 5.4-16.8) and adenoma (OR = 5.1; 95% CI: 3.4-7.8). Conclusion: Patients with DD are more likely to harbor colorectal lesions. These findings call for more vigilance on the part of endoscopists during colonoscopy in patients known to harbor colonic diverticula.

Rare Manifestation of a Rare Disease, Acute Liver Failure in Adult Onset Still's Disease: Dramatic Response to Methylprednisolone Pulse Therapy—A Case Report and Review

Adult onset Stills disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. It is characterized by daily fevers, arthralgias or arthritis, typical skin rash, and leukocytosis. Hepatic involvement is frequently observed in the course of AOSD with mildly elevated transaminases and/or hepatomegaly. Fulminant hepatic failure, occasionally requiring urgent liver transplantation, is a rare manifestation of AOSD. Here, we present a case of 22-year-old woman with no significant medical history who initially came with fever, arthralgias, myalgias, generalized weakness, and sore throat. Laboratory data showed mildly elevated transaminases and markedly elevated ferritin levels. She was diagnosed with AOSD based on Yamaguchi diagnostic criteria and was started on prednisone. Three months later, while she was on tapering dose of steroid, she presented with fever, abdominal pain, jaundice, and markedly elevated transaminases. Extensive workup excluded all potential causes of liver failure. She was diagnosed with AOSD associated acute liver failure (ALF). Intravenous (IV) methylprednisolone pulse therapy was started, with dramatic improvement in liver function. Our case demonstrated that ALF can present as a complication of AOSD and IV mega dose pulse methylprednisolone therapy can be employed as a first-line treatment in AOSD associated ALF with favorable outcome.

Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding

AIM To study the accuracy of using high definition (HD) scope with narrow band imaging (NBI) vs standard white light colonoscope without NBI (ST), to predict the histology of the colon polyps, particularly those < 1 cm. METHODS A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care. RESULTS Of participants in the study, 55 (37%) were male and median (interquartile range) of age was 56 (19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope (P = 0.7). The ST scope had a positive predictive value (PPV) and positive likelihood ratio (PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope (68%) compare to ST scope (53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp (HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar. CONCLUSION Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.

Sa1779 Prevalence of Adenoma Following Biopsies at Colonoscopy

at least one new peak compared to the product from the matching normal tissue. Statistical Analysis: The Kaplan-Meier method was used for estimating recurrence-free survival. Cox proportional hazard analysis was used to evaluate the association between MSI status and other clinicopathological factors for predicting recurrent distant metastasis. The P value less than 0.05 was considered to be statistically significant. Results: Stage II and III patients with MSI-L and/or EMAST had a shorter recurrence-free survival than patients with high levels of MSI (MSI-H) (P=0.0084) or with highly stable microsatellites (H-MSS) (P=0.0415) by Kaplan-Meier analysis. MSI-L and/or EMAST are independent predictors of recurrent distant metastasis in primary stage II and III CRCs by Cox proportional hazard analysis (Hazard Ratio: 1.83, 95%CI: 1.06-3.15, P=0.0301). Compatible with other studies, the present study also showed that MSI-H is associated with proximal location and exhibited lowest risk for recurrent distant metastasis. Conclusions: Our results showed that MSI-L/EMAST is a predictive factor of stage II/III primary CRC for recurrent distant metastasis. Because MSI-L/EMAST CRC is different from MSI-H and H-MSS CRC, we proposed to define MSI-L/EMAST as one group and named this group of CRC moderate MSI (MSI-M).

Sa1780 Colorectal Adenoma and Cancer Prevalence in Hispanics: A Hospital Based Study

Background: Among the race-ethnic groups in the US, African Americans have the highest colorectal cancer incidence and mortality whereas Hispanics have the lowest burden of the disease. Aim: To evaluate the prevalence of colorectal adenoma and carcinoma among inner city Hispanic population. Methods: We reviewed the reports of 1628 Hispanic patients who underwent colonoscopy at Howard University Hospital between 2000-2010. The mean age was 53.2 years, 64.2% were females. Advanced adenoma was defined as adenoma ≥ 1 cm in size or villous histology or high grade dysplasia or invasive cancer. Statistical analysis was performed using chi square statistics and t-test. Results: Among all patients, adenoma prevalence was 16.5% (n=268), advanced adenoma 2.3% (n=39), and colorectal cancer 0.4% (n=7). Hyperplastic polyps were seen in 6.6% of the cohort (n=107). Adenomas predominantly exhibited a proximal colonic distribution (53.7%, n=144); while hyperplastic polyps were mostly located in the distal colon (70%, n= 75). Among 11.7% (n=191) patients who underwent screening colonoscopy, the prevalence of colorectal lesions were 21.4% adenoma, 2.6% advanced adenoma; and 8.3% hyperplastic polyps. Conclusion: Our data showed low CRC prevalence among Hispanics; however colon adenoma prevalence was comparable to other ethnic and racial groups. Most colonic adenomas were located in the proximal colon, which supports the use of colonoscopy for CRC screening.

Sa1781 Colorectal Carcinoma in Young Urban Minorities

Background: Among the race-ethnic groups in the US, African Americans have the highest colorectal cancer incidence and mortality whereas Hispanics have the lowest burden of the disease. Aim: To evaluate the prevalence of colorectal adenoma and carcinoma among inner city Hispanic population. Methods: We reviewed the reports of 1628 Hispanic patients who underwent colonoscopy at Howard University Hospital between 2000-2010. The mean age was 53.2 years, 64.2% were females. Advanced adenoma was defined as adenoma ≥ 1 cm in size or villous histology or high grade dysplasia or invasive cancer. Statistical analysis was performed using chi square statistics and t-test. Results: Among all patients, adenoma prevalence was 16.5% (n=268), advanced adenoma 2.3% (n=39), and colorectal cancer 0.4% (n=7). Hyperplastic polyps were seen in 6.6% of the cohort (n=107). Adenomas predominantly exhibited a proximal colonic distribution (53.7%, n=144); while hyperplastic polyps were mostly located in the distal colon (70%, n= 75). Among 11.7% (n=191) patients who underwent screening colonoscopy, the prevalence of colorectal lesions were 21.4% adenoma, 2.6% advanced adenoma; and 8.3% hyperplastic polyps. Conclusion: Our data showed low CRC prevalence among Hispanics; however colon adenoma prevalence was comparable to other ethnic and racial groups. Most colonic adenomas were located in the proximal colon, which supports the use of colonoscopy for CRC screening.