lunes, 4 de diciembre de 2017

Signature Celebration of Gastroenterology, Colorectal Cancer. - PubMed - NCBI

2017 Nov 23. pii: S0016-5085(17)36387-4. doi: 10.1053/j.gastro.2017.11.029. [Epub ahead of print]

Signature Celebration of Gastroenterology, Colorectal Cancer.

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Abstract

Gastroenterology has published many seminal articles that have transformed our understanding of colorectal cancer (CRC) as well as being influential in promoting colorectal cancer screening which has saved many people from developing the disease. CRC has a hereditary component most notably highlighted in Lynch syndrome. A key paper reported that the majority of mutations in patients with hereditary nonpolyposis colorectal cancer harbored mutations in the MLH1 or MSH2 mismatch repair proteins. Continuing on the gene mutation theme, another paper. highlighted that serrated polyps accounted for approximately 9% of all colon polyps and the majority of these harbored BRAF mutations, a mutation rarely seen in the traditional adenoma to carcinoma sequence. The journal also published key work outlining the role of COX-2 in the development of CRC and this led to the concept that CRC may be prevented by COX-2 inhibition. Gastroenterology has published many influential guidelines to promote screening for colorectal cancer. Initially Gastroenterology guidelines emphasized the need for offering any screening modality either alone or in combination such as fecal occult blood test, flexible sigmoidoscopy, CT colography or colonoscopy. These guidelines were very influential in persuading governments around the world of the importance of CRC and now many countries in the developed world offer national CRC screening programs. More recently guidelines have emphasized the need to offer screening programs that prevent CRC as well as early detection and colonoscopy would be the gold standard approach. Gastroenterology has also led the way in developing the concept of developing quality measures. The journal has published evidence as to which measures lead to improvement in adenoma detection and reduced interval CRC rates. These papers have been instrumental in current recommendations on quality colonoscopy practice.