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Letters to the Editor
CONFLICT OF INTEREST The authors declare no conflict of interest. REFERENCES 1. Giardiello FM, Allen JI, Axilbund JE et al. Guidelines on genetic evaluation and management of lynch syndrome: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2014;109:1159–79. 2. Sinicrope FA, Mahoney MR, Smyrk TC et al. Prognostic impact of deficient DNA mismatch repair in patients with stage III colon cancer from a randomized trial of FOLFOXbased adjuvant chemotherapy. J Clin Oncol 2013;31:3664–72. 3. Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome in relatives. Genet Med 2009;11:35–41. 4. Hernandez MN, MacKinnon JA, Penberthy L et al. Enhancing central cancer registry treatment data using physician medical claims: a Florida pilot project. J Registry Manage 2014;41:51–6. 5. Institute of Medicine. Delivering High-Quality Cancer Care - Charting A New Course for a System in Crisis Brief Report. National Academy of Sciences: 2013. 1 University of Miami Miller School of Medicine, Miami, Florida, USA. Correspondence: Daniel A. Sussman, MD, MSPH, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 310J (D49), Miami, Florida 33136, USA. E-mail: [email protected]
“Are You a Gastroenterologist or a Philosopher?” Vincent Baty, MD, MPH1 doi:10.1038/ajg.2014.358
To the Editor: The article of Mosli et al. (1) interestingly assesses the individualized management of inflammatory bowel disease. The evolving paradigm of personalized medicine has already interested gastroenterology in the fields of hepatic disorders and gastroenterological malignancies. The need to turn toward a holistic view as a way to improve preventive nutrition has also been recently suggested The American Journal of GASTROENTEROLOGY
nature publishing group
(2). Should we consider the personalized approach as a reductionist one focused on the use of personal biomarkers or rather as a holistic one that takes into account the whole human body? “Are you a gastroenterologist or a philosopher?” The sentence came all of a sudden from an eminent colleague to whom I confided that the philosophical meaning of the modulation of the human gut microbiota (HGM) was puzzling, especially in the era of the bioenhancement debate. Did this mean a matter of skills? This sort of ultimatum might rather reflect a drastic dichotomy, which seems a bit simplistic and suggests that the reflection upon the relation between the mental representation of diet and the human bioenhancement debate has hardly been conveyed within the gastroenterological community. And yet, numerous studies dedicated to HGM research have suggested the potentiality of modulating the brain–gut axis through mere diet adjustments or through the use of synbiotics as a way to manage mental troubles or human behaviors. A new class of psychotropic agents, known as psychobiotics, has even been proposed (3). These advances might shed new light on the relationship between the individual representation of nutrition and the concept of self-fulfillment in the era of bioenhancement and cosmetic neurology. The cultural dimension of nutrition has to be reassessed from an updated study of the consumer’s imagination in the light of HGM modulation and of the enhancement debate. This might definitely help not only to face ethical considerations related to nutri-ethics (4) but also to investigate the parameters that could drive the forthcoming consumer’s food choice (5). Hence, should not we consider that we, exactly as gastroenterologists, are naturally interested in these fields, since gastroenterological practice intimately interacts with the mental representations of diet and digestion? Speeding up the brain–gut axis through diet modulation definitely underscores that “we are what we eat”. Aiming at personalized nutrition needs to go far beyond the assessment of dietary biomarkers. Fortunately, HGM research and the implementation of personalized medicine remind us that we, as gastroenterologists, are obliged
to make every endeavor in order to study this philosophical trend. CONFLICT OF INTEREST The author declares no conflict of interest. REFERENCES 1. Mosli MH, Sandborn WJ, Kim RB et al. Toward a personalized medicine approach to the management of inflammatory bowel disease. Am J Gastroenterol 2014;109:994–1004. 2. Fardet A, Rock E. Toward a new philosophy of preventive nutrition: from a reductionist to a holistic paradigm to improve nutritional recommendations. Adv Nutr 2014;5:430–46. 3. Dinan TG, Stanton C, Cryan JF. Psychobiotics: a novel class of psychotropic. Biol Psychiatry 2013;74:720–6. 4. Korthals M. Coevolution of nutrigenomics and society: ethical considerations. Am J Clin Nutr 2011;94(Suppl):2025S–9S. 5. Ahlgren J, Nordgren A, Perrudin M et al. Consumers on the internet: ethical and legal aspects of commercialization of personalized nutrition. Genes Nutr 2013;8:349–55. 1
Division of Gastroenterology, Clinique Mutualiste, Lyon, France. Correspondence: Vincent Baty, MD, MPH, Division of Gastroenterology, Clinique Mutualiste, 107 rue Trarieux, Lyon 69003, France. E-mail: [email protected]
Understanding the Biologic Behavior of Sessile Serrated Adenomas/Polyps Sahana Arumugam, BSc1, 5, Chantal M.C. le Clercq, MD1, 2, 5, Robert G. Riedl, MD3, Ad A.M. Masclee, MD, PhD1, 4 and Silvia Sanduleanu, MD, PhD1, 2 doi:10.1038/ajg.2014.347
To the Editor: With great interest we read the recent article by Tinmouth et al. (1) in this Journal, adding evidence on the importance of accurate detection, classification, and complete endoscopic resection of sessile serrated adenomas/polyps (SSAs/ Ps) to avoid the occurrence of post-colonoscopy colorectal cancers (PCCRCs). The biologic behavior of SSAs/Ps is sparsely understood. Here, we present the case of a patient who developed a PCCRC 4 years VOLUME 110 | JANUARY 2015 www.amjgastro.com
Letters to the Editor
CONFLICT OF INTEREST The authors declare no conflict of interest. REFERENCES 1. Giardiello FM, Allen JI, Axilbund JE et al. Guidelines on genetic evaluation and management of lynch syndrome: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2014;109:1159–79. 2. Sinicrope FA, Mahoney MR, Smyrk TC et al. Prognostic impact of deficient DNA mismatch repair in patients with stage III colon cancer from a randomized trial of FOLFOXbased adjuvant chemotherapy. J Clin Oncol 2013;31:3664–72. 3. Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome in relatives. Genet Med 2009;11:35–41. 4. Hernandez MN, MacKinnon JA, Penberthy L et al. Enhancing central cancer registry treatment data using physician medical claims: a Florida pilot project. J Registry Manage 2014;41:51–6. 5. Institute of Medicine. Delivering High-Quality Cancer Care - Charting A New Course for a System in Crisis Brief Report. National Academy of Sciences: 2013. 1 University of Miami Miller School of Medicine, Miami, Florida, USA. Correspondence: Daniel A. Sussman, MD, MSPH, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 310J (D49), Miami, Florida 33136, USA. E-mail: [email protected]
“Are You a Gastroenterologist or a Philosopher?” Vincent Baty, MD, MPH1 doi:10.1038/ajg.2014.358
To the Editor: The article of Mosli et al. (1) interestingly assesses the individualized management of inflammatory bowel disease. The evolving paradigm of personalized medicine has already interested gastroenterology in the fields of hepatic disorders and gastroenterological malignancies. The need to turn toward a holistic view as a way to improve preventive nutrition has also been recently suggested The American Journal of GASTROENTEROLOGY
nature publishing group
(2). Should we consider the personalized approach as a reductionist one focused on the use of personal biomarkers or rather as a holistic one that takes into account the whole human body? “Are you a gastroenterologist or a philosopher?” The sentence came all of a sudden from an eminent colleague to whom I confided that the philosophical meaning of the modulation of the human gut microbiota (HGM) was puzzling, especially in the era of the bioenhancement debate. Did this mean a matter of skills? This sort of ultimatum might rather reflect a drastic dichotomy, which seems a bit simplistic and suggests that the reflection upon the relation between the mental representation of diet and the human bioenhancement debate has hardly been conveyed within the gastroenterological community. And yet, numerous studies dedicated to HGM research have suggested the potentiality of modulating the brain–gut axis through mere diet adjustments or through the use of synbiotics as a way to manage mental troubles or human behaviors. A new class of psychotropic agents, known as psychobiotics, has even been proposed (3). These advances might shed new light on the relationship between the individual representation of nutrition and the concept of self-fulfillment in the era of bioenhancement and cosmetic neurology. The cultural dimension of nutrition has to be reassessed from an updated study of the consumer’s imagination in the light of HGM modulation and of the enhancement debate. This might definitely help not only to face ethical considerations related to nutri-ethics (4) but also to investigate the parameters that could drive the forthcoming consumer’s food choice (5). Hence, should not we consider that we, exactly as gastroenterologists, are naturally interested in these fields, since gastroenterological practice intimately interacts with the mental representations of diet and digestion? Speeding up the brain–gut axis through diet modulation definitely underscores that “we are what we eat”. Aiming at personalized nutrition needs to go far beyond the assessment of dietary biomarkers. Fortunately, HGM research and the implementation of personalized medicine remind us that we, as gastroenterologists, are obliged
to make every endeavor in order to study this philosophical trend. CONFLICT OF INTEREST The author declares no conflict of interest. REFERENCES 1. Mosli MH, Sandborn WJ, Kim RB et al. Toward a personalized medicine approach to the management of inflammatory bowel disease. Am J Gastroenterol 2014;109:994–1004. 2. Fardet A, Rock E. Toward a new philosophy of preventive nutrition: from a reductionist to a holistic paradigm to improve nutritional recommendations. Adv Nutr 2014;5:430–46. 3. Dinan TG, Stanton C, Cryan JF. Psychobiotics: a novel class of psychotropic. Biol Psychiatry 2013;74:720–6. 4. Korthals M. Coevolution of nutrigenomics and society: ethical considerations. Am J Clin Nutr 2011;94(Suppl):2025S–9S. 5. Ahlgren J, Nordgren A, Perrudin M et al. Consumers on the internet: ethical and legal aspects of commercialization of personalized nutrition. Genes Nutr 2013;8:349–55. 1
Division of Gastroenterology, Clinique Mutualiste, Lyon, France. Correspondence: Vincent Baty, MD, MPH, Division of Gastroenterology, Clinique Mutualiste, 107 rue Trarieux, Lyon 69003, France. E-mail: [email protected]
Understanding the Biologic Behavior of Sessile Serrated Adenomas/Polyps Sahana Arumugam, BSc1, 5, Chantal M.C. le Clercq, MD1, 2, 5, Robert G. Riedl, MD3, Ad A.M. Masclee, MD, PhD1, 4 and Silvia Sanduleanu, MD, PhD1, 2 doi:10.1038/ajg.2014.347
To the Editor: With great interest we read the recent article by Tinmouth et al. (1) in this Journal, adding evidence on the importance of accurate detection, classification, and complete endoscopic resection of sessile serrated adenomas/polyps (SSAs/ Ps) to avoid the occurrence of post-colonoscopy colorectal cancers (PCCRCs). The biologic behavior of SSAs/Ps is sparsely understood. Here, we present the case of a patient who developed a PCCRC 4 years VOLUME 110 | JANUARY 2015 www.amjgastro.com
