Sulindac in Familial Adenomatous Polyposis

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Abstract
Giardiello et al. (April 4 issue)1 conclude that sulindac does not delay the occurrence or reduce the number or size of colorectal adenomas in patients bearing a mutation of the adenomatous polyposis coli (APC) gene. The authors do not take into account two important factors: the position of the mutation in the germ-line APC gene and the level of expression of the wild-type allele in normal colonic mucosa and in adenomas. In familial adenomatous polyposis, there is a strong correlation between the location of the mutation in the APC gene and the age at onset and number and size of adenomas.2,3 Moreover, polymorphism of the mutated allele also influences the phenotype.4 This information is missing from the report by Giardiello et al.