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Answer to the Old Endoscopy Quiz - January 2017

December 31, 2016

The Old Endoscopy Quiz (and Answer) of the Month - January 2017


Click on the picture to get a magnification

Click on the picture to get a magnification

Click on the picture to get a magnification

Click on the picture to get a magnification

This old gentleman had suffered from obstipation for many many years and he 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. What disease is that?

Correct answer:

    (Pseudo-)melanosis coli, a dark brown pigmentation of the colon mucosa caused by the senna content in Agiolax (TM). There is surely no association between melanosis and the malignant tumour in the caecum.

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 sent by:

    Mohammed Taha, Doha, Qatar
    Panos mavropoulos, Xanthi, Greece
    Dr.Virendra Parikh, Fort Wayne, USA, Indiana
    kheira, Grenoble, france
    samah soliman, tanta, egypt
    rafik chihoub, Constantine, algeria
    Katerina Klapcic, Pula, Croatia
    THAV Sidanin, Bordeaux, France 
    andre das, subang jaya, malaysia
    Merab Buadze, Tbilisi, Georgia
    Merab Buadze, Tbilisi, Georgia
    Mario Galluzzi, Lecco, Italy
    Marianne Nilsson, Luleå, Sweden
    Mohammed. Hassan. Fathey TAha, Doha, Qatar
    Bereznai Sándor, Debrecen, Hungary
    Karen Stauffer, Monmouth, Illinois, USA
    Rashed hassen, Fakos, Egypt
    German Lloret Salom, Alzira, Spain
    Francesco, catania, italy
    Ibrahima Diallo, Dakar, Sénégal 
    subramanian, hosur, india/tamilnadu
    hanane delsa, rabat, morocco
    m.p.b Meilink, Enschede, Netherlands
    klera, Tirana, Albania
    F. de Clerck, Ghent, Belgium
    Ágota Mónus, Miskolc, Hungary
    Merab Buadze, Tbilisi, Georgia
    Tatjana Kovac, Istocno Sarajevo, BiH
    Ilona Troiceanu, Norwich, UK

May 1, 2016


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