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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 28, 2008; 14(28): 4492-4498
Published online Jul 28, 2008. doi: 10.3748/wjg.14.4492
Folic acid supplementation inhibits recurrence of colorectal adenomas: A randomized chemoprevention trial
Richard Jaszewski, Sabeena Misra, Martin Tobi, Nadeem Ullah, Jo Ann Naumoff, Omer Kucuk, Edi Levi, Bradley N Axelrod, Bhaumik B Patel, Adhip PN Majumdar
Richard Jaszewski, Sabeena Misra, Martin Tobi, Nadeem Ullah, Jo Ann Naumoff, Omer Kucuk, Edi Levi, Bradley N Axelrod, Bhaumik B Patel, Adhip PN Majumdar, John D Dingell Veterans Affairs Medical Center, Karmanos Cancer Institute, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, United States
Author contributions: Jaszewski R, Tobi M, Ullah N, Kucuk O: Patient recruitment, Colonoscopy, Manuscript preparation; Misra S, Patel BB: Data analysis and Manuscript preparation; Levi E: Pathological evaluation and Manuscript preparation; Naumoff JA: Nutritional assessment; Axelrod BN: Statistical analysis and manuscript preparation; Majumdar APN: Project design, overall supervision, manuscript writing.
Correspondence to: Adhip PN Majumdar, PhD, DSc, John D Dingell VA Medical Center, 4646 John R; Room B-4238, Detroit, MI 48201, United States. a.majumdar@wayne.edu
Telephone: +1-313-5764460
Fax: +1-313-5761112
Received: February 9, 2008
Revised: June 26, 2008
Accepted: July 3, 2008
Published online: July 28, 2008
Abstract

AIM: To determine whether folic acid supplementation will reduce the recurrence of colorectal adenomas, the precursors of colorectal cancer, we performed a double-blind placebo-controlled trial in patients with adenomatous polyps.

METHODS: In the current double-blind, placebo-controlled trial at this VA Medical Center, patients with colorectal adenomas were randomly assigned to receive either a daily 5 mg dose of folic acid or a matched identical placebo for 3 years. All polyps were removed at baseline colonoscopy and each patient had a follow up colonoscopy at 3 years. The primary endpoint was a reduction in the number of recurrent adenomas at 3 years.

RESULTS: Of 137 subjects, who were eligible after confirmation of polyp histology and run-in period to conform compliance, 94 completed the study; 49 in folic acid group and 45 in placebo group. Recurrence of adenomas at 3-year was compared between the two groups. The mean number of recurrent polyps at 3-year was 0.36 (SD, 0.69) for folic acid treated patients compared to 0.82 (SD, 1.17) for placebo treated subjects, resulting in a 3-fold increase in polyp recurrence in the placebo group. Patients below 70 years of age and those with left-sided colonic adenomas or advanced adenomas responded better to folic acid supplementation.

CONCLUSION: High dose folic acid supplementation is associated with a significant reduction in the recurrence of colonic adenomas suggesting that folic acid may be an effective chemopreventive agent for colorectal neoplasia.

Keywords: Folic acid; Adenoma; Colorectal cancer