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.
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)
