Low intestinal tract adenomatous polyps regression in FAP patients by dietary-induced erbeta upregulatior

The two primary surgical options for familial adenomatous polyposis (FAP) are total colectomy with ileorectal anastomosis (IRA) or total proctocolectomy with ileal pouch/anal anastomosis (IPAA). A strict endoscopic surveillance of the rectal stump as well of the pouch and the removal of polyps are needed during all life for FAP operated patients. Attempts to control the proliferation and to reduce the risk of recurrent polyps and to prevent carcinomas in the rectum or pouch have been tried in the past years especially with NAIDs. A diet supplementation with a patented blend of phytoestrogens and indigestible and insoluble fibers (Adipol®) is able to control or reduce adenomatous polyps in FAP patients and to modify the ERs expression in rectal or ileal pouch mucosa. At the basal time and every 6 months from the beginning of Adipol® administration, 17 patients were submitted to endoscopy and biopsy of the low intestinal tract for evaluation of the number, size and grade of adenoma dysplasia. After 6-12 months of treatment a significative decrease in the number of polyps was observed, while the dimension remains stable in 11 patients and decreases in 6. A passage from severe to mild dysplasia was present in 3 patients and a passage from adenomatous pattern to simple phlogosis in 4 patients. The proliferative and apoptotic activity was not significantly varied, while ER-β mRNA expression was progressively and significantly upregulated, during the treatment. Dietary supplementation with phytoestrogens can prevent the formation of new polyps with good tolerability and without side effects.