Effect of folate supplementation on the incidence of dysplasia and cancer in chronic ulcerative colitis. A case-control study.
Lashner BA; Heidenreich PA; Su GL; Kane SV; Hanauer SB
Gastroenterology 1989 Aug;97(2):255-9
Folate deficiency has been associated with dysplasia in human cancer
models. Patients with ulcerative colitis commonly have decreased folate
levels, which are partially due to sulfasalazine, a competitive inhibitor
of folate absorption. To study the effect of folate supplementation on
the risk of dysplasia or cancer (neoplasia) in ulcerative colitis, records
from 99 patients with pancolitis for greater than 7 yr and enrolled in
a surveillance program were reviewed. Thirty-five patients with neoplasia
were compared with 64 patients in whom dysplasia was never found to determine
the effect of folate supplementation on the rate of development of neoplasia
using case-control methodology. At the time of the index colonoscopy,
patients with neoplasia were older (43 +/- 11 vs. 39 +/- 12 yr) and had
disease of longer duration (20 +/- 8 vs. 15 +/- 7 yr, p less than 0.05).
Folate supplementation was associated with a 62% lower incidence of neoplasia
compared with individuals not receiving supplementation (odds ratio, 0.38;
95% confidence interval, 0.12-1.20). There was no appreciable change in
this effect when models were fit to adjust for sulfasalazine dose, duration
of disease, age at symptom onset, prednisone dose, sulfa allergy, sex,
race, or family history of colon cancer. The statistical power of the
association between folate supplementation and neoplasia was 72%. Correction
of risk factors before the development of neoplasia may prevent this serious
complication. Pending a larger case-control study, folate supplementation
during sulfasalazine administration is recommended to possibly prevent
the complication of dysplasia or cancer in ulcerative colitis.
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