Therapeutic Focus

Cosmo’s therapeutic focus is on the oral and endoscopic treatment of colon diseases. Many colon diseases are recurring, some are chronic. This means that their treatment by systemic route bears the risk of serious side effects which is why Cosmo focuses on treating these diseases either orally with tablets or by endoscopic applications.

Inflammatory Bowel Diseases (IBD) are a group of chronic, progressive, recurring and debilitating disorders characterized by severe damage of the gastro-intestinal tract. The main forms of IBD are Ulcerative Colitis and Crohn’s Disease. Both diseases are clinically similar and may be described as a faulty regulation of the mucosal immune response.

The causes of Inflammatory Bowel Disease are not known but it is widely believed that they could be ascribed to an auto-immune mechanism.

Inflammatory Bowel Disease currently affects approximately 0.5% of the Western world’s population. According to the U.S. Crohn’s and Colitis Foundation, the Ulcerative Colitis and Crohn’s Disease U.S. population size is estimated to be in excess of 1.4 million patients.

Colon Infections

Colon infections are a group of diseases which range from short infections such as travelers’ diarrhea to hepatic encephalopathy, IBSD, clostridium dificile to the chronic diverticulitis.

The most frequent colon infection is travelers’ diarrhea which primarily strikes people traveling to developing countries after ingesting food or drinks that are contaminated by bacteria. It is estimated that 50 million persons travel to developing countries every year and that around 40% of these will get travelers diarrhea.

Hepatic encephalopathy is caused by cirrhosis of the liver when the liver can no longer perform all its bacteria cleaning functions. The toxins can then travel to the brain and cause severe brain damage. 

Clostridium difficile colitis results from a disturbance of the normal bacterial flora of the colon, colonization by C difficile, and the release of toxins that cause mucosal inflammation and damage. Antibiotic therapy is the key factor that alters the colonic flora. C difficile infection (CDI) occurs primarily in hospitalized patients.

Diverticulosis happens when pouches (diverticula ) form in the wall of the colon. It is presumed that about 60% of the 60 year olds have diverticula, 70% of the 70 years olds etc. it is presumed that pressure that the peristaltic muscle structure become more brittle as persons age and that pressure from within the colon then causes the pouches to form  If these pouches get inflamed or infected, it is called diverticulitis. This happens in approximately 10-20% of all cases. Diverticulitis can be very painful.

Colon cancer 

Colon Cancer is the third most frequent cancer. Epidemiologists estimate that at birth, every person has a 5% chance of contracting colon cancer during its life time with the disease primarily striking persons that are older than 45 years old. Various drugs have been developed to treat colon cancer; the 5 year survival rate is 62% in the USA and 52% in Europe. However, since practically all colon cancers develop from adenomas, colon cancer is the only cancer that theoretically could be eradicated by developing means of detecting the adenomas as early as possible and by extracting them without major surgery.  

Numerous attempts have been made at developing adenoma detection instruments, the oldest being the fecal occult blood test (FOBT). In this test the subject takes a sample of its stool, smears this on a test strip and sends the strip to a laboratory where the stool sample is analyzed for its blood content. This is then taken as a confirmation that there is a bleeding event somewhere in the colon. Since all colon cancers tend to seep blood and many adenomas do so as well, the subject is then indicated for a full colonoscopy to identify and extract the cause of bleeding. FOBTs however are not very precise because the most frequent bleeding events come from hemorrhoids and because many adenomas do not bleed.

In Europe it is a standard procedure in many countries that each subject, upon its 50th birthday, gets sent a FOBT test and is urged to send in a stool sample for analysis. If this proves positive the subject is then referred to a colonoscopy. In the USA the use of FOBT tests is less frequent with subjects in the great majority opting for a direct colonoscopy.

The increased frequency of preventive measures has had a strong impact on colon cancer incidence. In 2000 it was estimated that by 2015 approximately 200’000 subjects would be diagnosed with colon cancer. The most recent estimates made by the US authorities now project cancer diagnoses to be down to 134’490 subjects, a substantial decrease only due to increased colonoscopies. In Europe it is estimated 447’000 persons are diagnosed with colon cancer in 2016.

In order to identify polyps, endoscopists perform colonoscopies which allow a visual inspection of the colon via endoscope. During colonoscopy, endoscopists strive to identify all polyps and remove those potentially dangerous. Removal of polyps can be challenging, especially if the polyp is flat or positioned in difficult areas.

In the USA and EU around 32 million colonoscopies are performed every year.
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