Berberine Reduces Metachronous Colorectal Adenomas in Randomized Trial
Douglas K. Rex, MD, FASGE, reviewing Chen YX, et al. Lancet Gastroenterol Hepatol 2020 Jan 8.
Berberine is a Chinese herbal extract used to treat diarrhea and enteritis and is widely sold (including in the U.S.) as a dietary supplement. There is some evidence it can block tumorigenesis. About 1100 Chinese patients with a history of colorectal adenomas were randomized to receive 0.3 grams of berberine twice daily or placebo in a double-blind trial. Patients underwent colonoscopy one year after enrollment, and if they had no adenomas at the one-year follow-up, a second colonoscopy was performed at two years.
At the end of two years of follow-up, 36% of 429 berberine recipients who had completed follow-up had developed adenomas compared to 47% of patients in the placebo group (relative risk, 0.77; P=.001). Advanced adenomas were found in 3% of the berberine group and 6% of the placebo group (P=.05). There was no difference in side effects, with about 1% of berberine patients developing constipation.
COMMENT
On the internet, berberine is promoted as a relatively inexpensive dietary supplement that treats metabolic syndrome, diabetes, and lipid elevation. Its most common side effects are GI related and are reversible with cessation. Now there is evidence from a randomized controlled trial that berberine reduces adenoma recurrence. Given the safety profile and low cost, it seems to be a reasonable option to discuss with high-risk adenoma patients interested in reducing polyp and cancer risk.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
![d-rex](https://www.endoscopy-campus.com/wp-content/uploads/d-rex.jpg)
Douglas K. Rex, MD, FASGE
CITATION(S)
Chen YX, Gao QY, Zou TH, et al. Berberine versus placebo for the prevention of recurrence of colorectal adenoma: a multicentre, double-blinded, randomised controlled study. Lancet Gastroenterol Hepatol 2020 Jan 8. (Epub ahead of print) (https://doi.org/10.1016/S2468-1253(19)30409-1)