结直肠肿瘤的化学预防:AGA最新建议
  • 一般风险人群(预期寿命>10年、有CVD风险但无出血高风险且<70岁),应使用小剂量阿司匹林来降低结直肠癌(CRC)的发生和死亡,但不应使用非阿司匹林NSAIDs(有心血管和胃肠道不良事件的重大风险)和他汀预防CRC;
  • 有CRC病史者,考虑使用阿司匹林(不能用他汀)来预防复发性结直肠肿瘤;
  • 2型糖尿病和CRC患者,考虑使用二甲双胍来预防前者的结直肠肿瘤发生和降低两病合并的死亡率;
  • 不应使用钙或维生素D、叶酸来预防结直肠肿瘤。
主编推荐语
爱的抉择
Gastroenterology近期发表了美国胃肠病协会(AGA)的专家评述,通过对文献的回顾性研究,总结了结直肠肿瘤化学预防的药物使用的临床实践经验,提供了药物使用的最佳实践声明,但缺乏对证据的质量或建议的准确性进行正式的系统审查和评级,临床上应用需谨慎对待。
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Gastroenterology [IF:17.373]

AGA Clinical Practice Update on Chemoprevention for Colorectal Neoplasia: Expert Review

结直肠肿瘤化学预防的AGA临床实践更新:专家述评

10.1016/j.cgh.2021.02.014

02-09, Other

Abstract & Authors:展开

Abstract:收起
Description: The purpose of this expert review is to describe the role of medications for the chemoprevention of colorectal neoplasia. Neoplasia is defined as precancerous lesions (e.g., adenoma and sessile serrated lesion) or cancer. The scope of this review excludes dietary factors and high-risk individuals with hereditary syndromes or inflammatory bowel disease.
Methods: The best practice advice statements are based on a review of the literature to provide practical advice. A formal systematic review and rating of the quality of evidence or strength of recommendation were not performed. BEST PRACTICE ADVICE 1: In individuals at average risk for CRC who are 1) younger than 70 years with a life expectancy of at least 10 years, 2) have a 10-year cardiovascular disease risk of at least 10% a, and 3) not at high risk for bleeding, clinicians should use low-dose aspirin to reduce CRC incidence and mortality. BEST PRACTICE ADVICE 2: In individuals with a history of CRC, clinicians should consider using aspirin to prevent recurrent colorectal neoplasia. BEST PRACTICE ADVICE 3: In individuals at average risk for CRC, clinicians should not use non-aspirin NSAIDs to prevent colorectal neoplasia because of a substantial risk of cardiovascular and gastrointestinal adverse events. BEST PRACTICE ADVICE 4: In individuals with type 2 diabetes, clinicians may consider using metformin to prevent colorectal neoplasia. BEST PRACTICE ADVICE 5: In individuals with CRC and type 2 diabetes, clinicians may consider using metformin to reduce mortality. BEST PRACTICE ADVICE 6: Clinicians should not use calcium or vitamin D (alone or together) to prevent colorectal neoplasia. BEST PRACTICE ADVICE 7: Clinicians should not use folic acid to prevent colorectal neoplasia. BEST PRACTICE ADVICE 8: In individuals at average risk for CRC, clinicians should not use statins to prevent colorectal neoplasia. BEST PRACTICE ADVICE 9: In individuals with a history of CRC, clinicians should not use statins to reduce mortality.

First Authors:
Peter S Liang

Correspondence Authors:
Peter S Liang

All Authors:
Peter S Liang,Aasma Shaukat,Seth D Crockett

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