Review article: anthranoid laxatives and their potential carcinogenic effects

Abstract

Anthranoid laxatives are widely used laxatives of natural origin. Because of their chemical structure they are carried unabsorbed to the large bowel, where metabolism to the active aglycones takes place. These aglycones exert their laxative effect by damaging epithelial cells, which leads directly and indirectly to changes in absorption, secretion and motility. Damaged epithelial cells can be found as apoptotic bodies in the pigmented colonic mucosa, characteristic for pseudomelanosis coli. Pseudomelanosis coli is a condition caused by chronic (ab)use of anthranoid laxatives and has recently been associated with an increased risk of colorectal carcinoma. In vitro and animal studies have shown a potential role of anthranoid laxatives in both the initiation and promotion of tumorigenesis. Studies in humans have also suggested tumour promoting activities for these laxatives. Although the short-term use of these substances is generally safe, long-term use cannot be recommended.

Risk and Protective Factors for Development of Colorectal Polyps and Cancer

“…This result is supported by some other studies (Van Gorkom et al, 1999). Probably, laxatives exert direct toxic effect upon colon mucosa.…”

Herbal remedies are the main etiologic factor in melanosis coli, a case series study

“…The apoptotic cells appear as darkly pigmented bodies that are taken up by macrophages. When sufficient cells have been damaged, the distinctive pigmentation of the bowel wall develops [1,[11][12][13].…”

Inhibitory Effects of Low-Dose Aloe-Emodin on the Development of Colorectal Tumors in Min Mice

“…Anthranoid (anthraquinone, dianthrone, or anthrone)-containing laxatives, such as aloe, cascara, frangula, and rheum, may be a risk factor for the induction of colorectal tumors (Siegers, 1992;1993;van Gorkom et al, 1999). Mori et al (1985;1986) reported that the synthetic 1,8-dihydroxyanthraquinone (other names used include danthron or chrysazin) induced tumors in the large intestines and livers of rodents.…”