Folic acid in preventing recurrence of colorectal adenomas : is it effective?

Abstract

The high incidence of patients with recurrent colorectal adenomas have increased interest among researchers in finding a vitamin supplement which may act as a chemo-preventive agent against the development of these lesions. Folic acid was found to be beneficial for various health reasons and also was believed to have an association with the improvement in the DNA methylation of the inner wall lining of the bowel. Therefore the proposed research question for this dissertation is: In patients with a history of colorectal adenomas is folic acid effective in preventing recurrence? An evidence-based approach was used to answer this question. An extensive search using different databases, keywords and MeSH terms ensured the retrieval of pertinent research articles. The PRISMA flow diagram framework was utilised to ensure reliability and validity of the search process. Moreover the use of inclusion and exclusion criteria resulted in the retrieval of 3 meta-analyses and 4 randomised clinical trials. These rank high in the hierarchy of evidence. The Critical appraisal tools adopted from Ajetunmobi (2002) were used to appraise the methodologies of the retrieved studies. The guidelines adopted from Rebar, Gersch, Macnee and McCabe (2011) were used to critique ethical issues of each study, thus ensuring a systematic process. The overall findings of the studies showed no clear increase or decrease in recurrence among patients with a history of colorectal adenomas. That is the findings were inconclusive. Such inconclusive findings could possibly be attributed to folic acid having a dual effect on adenoma development and carcinogenesis. This suggests the need for further high quality research to possibly obtain conclusive results. In this report, it was recommended that education of healthcare professionals and the public is fundamental to prevent any possible consequences when using folic acid in patients with an adenoma history. Until further evidence suggests otherwise, it was recommended that patients with adenoma history should use these supplements with caution and with the physicians' advice. The implementation of more randomised trials was also recommended both at a local level and other foreign countries.