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Our Blog: The Old Endoscopy Quiz - October 2014

November 1, 2014

The Old Endoscopy Quiz (and Answer) of the Month - October 2014


Click on the image to get a magnification!

This old gentleman had suffered from obstipation for many many years and hed had treated this with an over the counter drug named Agiolax (TM). Then he came to a colonoskopy as he had developed a quite severe iron deficiency anaemia. This is the finding in the caecal region. Obviously he has a malignant caecal tumour, adenocarcinoma. But there is another disease clearly visible in these images, possibly related to the caecal malignancy. What disease is this?


    (Pseudo-)Melanosis Coli.

    Here an article dealing with the use of senna and risk of cancer:

    J Toxicol. 2009; 2009: 287247.

    Is Senna Laxative Use Associated to Cathartic Colon, Genotoxicity, or Carcinogenicity?

    M. A. Morales,1* D. Hernández,2 S. Bustamante,1 I. Bachiller,3 and A. Rojas4 1Departamento de Farmacologia, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, 8380453 begin_of_the_skype_highlighting 8380453 end_of_the_skype_highlighting Independencia, Santiago, Chile 2Departamento de Ciencias Biológicas, Facultad Ciencias de la Salud, Universidad Andrés Bello, República 217, Santiago, Chile 3Sociedad Asturiana de Fitoterapia, 33005 Oviedo, Asturias, Spain 4Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad Católica del Maule, Casilla 617, Talca, Chile
    Recommended by Michael Cunningham
    Received June 8, 2009; Accepted August 11, 2009.
    This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


    Due to their natural origin, apparent low oral toxicity, effectiveness, and accessibility without a medical prescription, the anthranoid laxatives are a popular remedy for constipation and are frequently used abusively. Therefore, it is important to characterize its harmful and/or toxic effects. The sennosides, main active metabolites of senna, exhibit a very low toxicity in rats, and its genotoxic activity in bacterial strains as well as mammal cells was classified as weak in those cases where it was shown to be significant. The toxicological and mutagenic status of the crude extract of senna, however, is not as well characterized, and it is necessary to do so since it is frequently, and at the same time incorrectly, believed that the chronic use of anthranoid laxatives is a risk factor for the development of colorectal cancer. The objective of this article was to review the information that arises in various scientific medical databases using key words such as senna, sen, Senna alexandrina, Cassia angustifolia, sennosides, laxative toxicity, mainly ISI and non-ISI articles of journals with an editorial committee. Web pages of products or companies that publicize or commercialize this type of laxative were not included. This analysis establishes that (1) there is no convincing evidence that the chronic use of senna has, as a consequence, a structural and/or functional alteration of the enteric nerves or the smooth intestinal muscle, (2) there is no relation between long-term administration of a senna extract and the appearance of gastrointestinal tumors or any other type in rats, (3) senna is not carcinogenic in rats even after a two-year daily dose of up to 300 mg/kg/day, and (4) the current evidence does not show that there is a genotoxic risk for patients who take laxatives containing senna extracts or sennosides.


Correct answers were emailed by

    Márcio Paraboli, São José do Rio Preto-SP, BRAZIL
    Mario Galluzzi, Lecco, Italy
    Omar makhlouf, France

Summer in Moscow, Russia
    Myomintun, Moscow, Russia
    Eliseo rangel, México, Distrito Federal, México
    senior, sanaa, Yemen
    DIMAKOPOULOS KONSTANTINOS, Thessalonikii, Greece
    jose garrido, pilar, Argentina
    mahmoud salama, qena, Egypt
    said yahia, ghardaia, Algeria
    Ágota Mónus, Miskolc, Hungary
    B.Tsatsral, Ulaanbaatar, Mongolia
    Dr.Virendra Parikh, Fort Wayne, USA/Indiana
    Ahmed Galal, Alexandria, Egypt
    Mr. Vygantas G., Marijampole, Lithuania
    delsa hanane, rabat, Morocco
    A. Oponowicz, Janów Lubelski, Poland
    Marianne Nilsson, Luleå, Sweden
    Altin Cekodhima, Tirana, Albania
    Abuouda Hussam, gaza, Palestine
    Youssef El-Taher, cairo, Egypt
    Melanie Fuller, Merthyr Tydfil, UK Wales
    Arzu, Azerbaijan
    omar m albashir, KHARTOUM, SUDAN
    Dunja Jaksic, Belgrade, Serbia
    awajdarip, khartoum, sudan
    Moustapha el chaki, Jeddah, Ska
    Garrido Matias, buenos aires, Argentina
    Saeid Aslani, Aalborg Universtity Hospital, Denmark
    HB-SJRP, São José do Rio Preto, SP
    Cina, Preov, Slovakia


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November 1, 2014