Læknablaðið : fylgirit - 01.06.1996, Page 13

LÆKNABLAÐIÐ 1996; 82/FYLGIRIT 31
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rather to identify those who vill not cause new un-
wanted side effects. An unexpected advantage of
Cox-2 inhibitors is that they do not uncouple in-
testinal mitochondrial oxidative phosphorylation,
the key intiation step in the gastrointestinal toxicity
of these drugs. The gastrointestinal safety of the
highly specific Cox-2 inhibitors is already evident
from volunteer and patient studies and the race is on
for the successful introduction of the first one into
clinical practice. It is anticipated, provided that ade-
quate efficacy is achieved, that within 5 years con-
ventional NSAIDs will be restricted for use in pa-
tients with cardiovascular problems with consider-
able loss of income for gastroscopists.
The conventional gastroenterologist may fare bet-
ter elsewhere. The genetic evolution of colonic can-
cer is rapidly emerging, involving initial inactivation
of the adenomatous polyposis coli tumor suppres-
sion gene (associated with hyperproliferative epi-
thelium) followed sequentially by activation of the
RAS oncogene (adenoma), inactivation of DCC
(large adenoma) and p53 (malignancy) with the
promise of expansion of colonoscopic surveillance
and targeted treatment. My prediction is however
that by the year 2001 the World Health Organisation
will have agreed a global ban on gastroenterologists
treating Helicobacter pylorí, having with their idio-
syncratic prescribing habits cultured a malignant,
multi-resistant strain of this microbe.