Sulindac therapy of colorectal polyps in familial adenomatous polyposis

Familial adenomatous polyposis (FAP) is characterized by multiple adenomatous colorectal polyps, some of which progress to adenocarcinoma in the absence of surgery. Colectomy with ileorectal anastomosis still remains much in use, although strict surveillance of the rectal stump is necessary to prevent rectal cancer. After 1983, sulindac has been used to control rectal polyps in about 90 FAP patients, at doses of 150-400 mg/day. The treatment was well tolerated, and regression of the polyps was frequently observed. However, recurrence of polyps was sometimes observed, and the onset of rectal cancer during sulindac therapy was also reported. A review of the literature and the personal experience of the authors are here presented, discussing the pharmacological profile and possible mechanisms of action of sulindac.