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Brignoli A, Ferrara E, Zannetti M, Loi G, Forti L, Socci C, Carriero A, Gennari A, Krengli M, Franco P. Capecitabine-Induced Ileitis during Neoadjuvant Pelvic Radio-Chemotherapy for Locally Advanced Rectal Cancer: A Case Report with Literature Review. Curr Oncol 2023; 30:9063-9077. [PMID: 37887555 PMCID: PMC10605187 DOI: 10.3390/curroncol30100655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
We report on a clinical case of capecitabine-induced acute ileitis in a patient treated with pre-operative concurrent chemoradiation with capecitabine for locally advanced rectal cancer and provide a comprehensive literature review. This a rare, but life-threatening, clinical situation, that clinicians should be aware of. Severe persistent diarrhea is the most frequent clinical feature and computed tomography is a valid tool for diagnosis. Conservative management includes capecitabine withdrawal, antidiarrheal therapy and endovenous hydration, together with dietary modifications and broad-spectrum antibiotics. Pelvic irradiation represents an adjunctive risk factor, which may increase the likelihood of occurrence of terminal ileitis. Early recognition and prompt intervention are crucial for successful clinical management.
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Affiliation(s)
- Andrea Brignoli
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (A.B.); (E.F.); (M.Z.)
- Department of Translational Medicine, University of the Eastern Piedmont, 28100 Novara, Italy; (A.C.); (A.G.)
| | - Eleonora Ferrara
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (A.B.); (E.F.); (M.Z.)
| | - Micol Zannetti
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (A.B.); (E.F.); (M.Z.)
| | - Gianfranco Loi
- Department of Medical Physics, University Hospital “Maggiore della Carità”, 28100 Novara, Italy;
| | - Laura Forti
- Division of Medical Oncology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy;
| | - Carlo Socci
- Division of Surgery, Hospital ‘S.S. Trinita’, 28021 Borgomanero, Italy;
| | - Alessandro Carriero
- Department of Translational Medicine, University of the Eastern Piedmont, 28100 Novara, Italy; (A.C.); (A.G.)
- Division of Radiology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy
| | - Alessandra Gennari
- Department of Translational Medicine, University of the Eastern Piedmont, 28100 Novara, Italy; (A.C.); (A.G.)
- Division of Medical Oncology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy;
| | - Marco Krengli
- Radiation Oncology, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy;
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padua, Italy
| | - Pierfrancesco Franco
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (A.B.); (E.F.); (M.Z.)
- Department of Translational Medicine, University of the Eastern Piedmont, 28100 Novara, Italy; (A.C.); (A.G.)
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2
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Ojukwu K, Cox BK, Larson BK, Guindi M, Waters KM, Hutchings DA. Capecitabine-induced Gastrointestinal Injury Shows a Graft-Versus-Host Disease (GVHD)-like Pattern. Am J Surg Pathol 2023; 47:1160-1167. [PMID: 37493102 DOI: 10.1097/pas.0000000000002093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Capecitabine is a commonly used oral chemotherapeutic agent. Gastrointestinal (GI) side effects are clinically well-known, however, the histopathologic changes have not been comprehensively studied. This study describes the largest case series (8 patients) characterizing the histopathology of capecitabine-induced GI injury. All patients were adults (median age: 64.5 y, range: 61 to 76 y) and there was gender parity. Patients were receiving treatment for malignancies of the colorectum (n=5), breast (n=1), pancreas (n=1), and appendix (n=1). All had GI symptoms, including 7 with diarrhea and abdominal pain and 1 with melena. Five of 8 (63%) showed graft-versus-host disease (GVHD)-like histologic changes in small intestinal and/or colonic biopsies characterized by crypt disarray and dropout, crypt atrophy, dilated crypts lined by attenuated epithelium, and increased crypt apoptosis. Neuroendocrine cell aggregates were present in 4 of 5 cases. Four of 5 showed patchy prominence in lamina propria eosinophils. One patient receiving concomitant radiation therapy had a small intestinal biopsy showing regenerative changes. Two patients had histologically unremarkable biopsies. On follow-up, capecitabine was discontinued or dose-reduced in all patients. Three of 5 patients with a GVHD-like pattern had clinical improvement, whereas 2 died shortly after biopsy. One with regenerative changes also had radiation dose reduction and improved clinically. Two with unremarkable biopsies improved symptomatically. In summary, capecitabine-related GI injury shows a GVHD-like pattern. Knowledge of this is important to confirm the diagnosis as patients typically improve with dose reduction or discontinuation of the drug.
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Affiliation(s)
- Kenechukwu Ojukwu
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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3
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Jenvrin A, Perret A, Palmieri LJ, Soularue E, Broudin C, Rance B, Taieb J, Gallois C. Chemotherapy-induced ileitis associated or not with colitis in digestive oncology patients: An AGEO multicentre study. Dig Liver Dis 2023; 55:1426-1433. [PMID: 37045619 DOI: 10.1016/j.dld.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/06/2023] [Accepted: 03/07/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The characteristics and management of ileitis induced by chemotherapy in cancer patients are poorly described in the literature. METHODS This retrospective multicentre study enroled patients hospitalized in a digestive oncology unit for a symptomatic chemotherapy-induced ileitis. RESULTS Forty-three patients were included, with a regimen based on fluoropyrimidine and/or irinotecan in 95% of cases. Five patients were excluded due to the diagnosis of infectious ileitis (Clostridium difficile in 3 patients, Campylobacter jejuni in 1 patient and cytomegalovirus in 1 patient). The most frequently described symptoms were diarrhoea (77% including 54% of grade 3-4 diarrhoea), abdominal pain (58%), fever (51%) and vomiting (56%). An ileo-colonoscopy was performed in 35% of patients and did not show any specific results or severity criteria. The ileitis was complicated by bowel perforation and/or obstruction in 3 patients. Disease progression was favourable in 1-2 weeks in the vast majority of cases, on symptomatic treatment, allowing resumption of the chemotherapy regimen involved in 67% of patients. CONCLUSION Chemotherapy-induced ileitis is a rare complication that most often involves fluoropyri-midine- and/or irinotecan-based regimens. In most cases, endoscopic examinations were not contributory and do not seem useful in the event of non-severe symptomatology which most often develops favourably on symptomatic therapy, allowing resumption of the chemotherapy involved.
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Affiliation(s)
- Anaïs Jenvrin
- Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | - Audrey Perret
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Lola-Jade Palmieri
- Assistance Publique-Hôpitaux de Paris, Gastroenterology and Digestive Oncology Department, Cochin Hospital, Paris, France
| | - Emilie Soularue
- Institut Mutualiste Montsoutris, Department of Medical Oncology, Paris, France
| | - Chloé Broudin
- Paris University; Assistance Publique-Hôpitaux de Paris, Department of Pathology, Hôpital Européen Georges Pompidou, Paris, France
| | - Bastien Rance
- Université Paris Cité, Inserm, Centre de Recherche des Cordeliers; Assistance Publique-Hôpitaux de Paris, Department of Medical Bioinformatics, Hôpital Européen Georges Pompidou, Paris, France
| | - Julien Taieb
- Paris Cité University; Siric CARPEM; Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | - Claire Gallois
- Paris Cité University; Siric CARPEM; Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, Paris, France.
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4
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Trontzas IP, Rapti VE, Syrigos NK, Gomatou G, Lagou S, Kanellis G, Kotteas EA. Capecitabine-associated enterocolitis: Narrative literature review of a rare adverse event and a case presentation. J Chemother 2023; 35:63-71. [PMID: 35014596 DOI: 10.1080/1120009x.2021.2025316] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Capecitabine is an oral 5-fluorouracil prodrug with antimetabolite activity commonly used in advanced colorectal and breast cancer. It presents with a generally good toxicity profile and most of the adverse events can be managed effectively. Enterocolitis is a rare, under-reported, but potentially fatal adverse event associated with capecitabine use. To the best of our knowledge, there are 21 cases of capecitabine-related enterocolitis reported in the literature. We herein present a narrative literature review of enteritis/colitis cases associated with capecitabine use, with highlight to the most common clinical presentation, common imaging and microscopic findings and management approach. We furthermore present a case of severe capecitabine-related enteritis.
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Affiliation(s)
- Ioannis P Trontzas
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - Vasiliki E Rapti
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - Nikolaos K Syrigos
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - Georgia Gomatou
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - Styliani Lagou
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - George Kanellis
- Hematopathology Department, Evangelismos Hospital, Athens, Greece
| | - Elias A Kotteas
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
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5
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Zou Y, Liu S, Wu J, Sun Z. Severe ileum bleeding following adjuvant capecitabine chemotherapy for locally advanced colon cancer: a case report and review of the literature. World J Surg Oncol 2021; 19:332. [PMID: 34809643 PMCID: PMC8609886 DOI: 10.1186/s12957-021-02443-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Capecitabine is a prodrug that is enzymatically converted to its active form, fluorouracil (also called 5-fluorouracil), which is commonly used as adjuvant chemotherapy in colorectal cancer patients. Severe gastrointestinal bleeding induced by capecitabine is rare. Here, we are presenting the first case report of surgery specimen assisted diagnosis of this uncommon condition. CASE PRESENTATION A 63-year-old Chinese male with a history of colon adenocarcinoma and right hemicolectomy presented with severe lower gastrointestinal bleeding 2 days after finishing capecitabine administration during the first cycle of XELOX adjuvant chemotherapy. Because of the negative findings of active bleeding points by digital subtraction angiography (DSA) or colonoscopy, emergency laparotomy and partial enterectomy were performed. The bloody diarrhea had resolved after surgery and a terminal ileitis was diagnosed after pathological examination of the surgical specimen. CONCLUSIONS Terminal ileitis induced by capecitabine is likely to be underreported. It should be considered more often as a cause of severe gastrointestinal bleeding during or after treatment with capecitabine agents. Emergency surgery may achieve satisfactory outcomes if endoscopic hemostasis is ineffective. HIGHLIGHTS OF THIS CASE 1. Gastrointestinal bleeding following capecitabine treatment in colorectal cancer patients might be life-threatening. 2. Terminal ileitis induced by capecitabine should always be considered in the differential diagnosis of severe gastrointestinal bleeding. 3. Awareness of the risk factors such as deficiency of dihydropyrimidine dehydrogenase, advanced age, or right colectomy may aid in reducing capecitabine-related morbidity. 4. When severe bleeding occurs, emergency surgery may achieve satisfactory outcomes if medical and endoscopic interventions are ineffective.
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Affiliation(s)
- You Zou
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China.,Tongji Cancer Research Institute, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuang Liu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China.,Tongji Cancer Research Institute, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianhong Wu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China.,Tongji Cancer Research Institute, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Sun
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China. .,Tongji Cancer Research Institute, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China.
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6
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Klimko A, Tieranu CG, Olteanu AO, Preda CM, Ionescu EM. Capecitabine-Induced Terminal Ileitis: Case Report and Literature Review. Cureus 2021; 13:e14621. [PMID: 34055501 PMCID: PMC8144076 DOI: 10.7759/cureus.14621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Capecitabine is a well-established agent for adjuvant chemotherapy in breast and colorectal cancers. However, one of the limiting adverse events of this therapy is severe diarrhea, which is reported with increasing frequency as of late. Capecitabine-induced ileitis should be suspected in cases with severe, treatment-refractory diarrhea. We present a case of capecitabine-induced terminal ileitis in a patient who received the medication as adjuvant therapy for previously resected colon adenocarcinoma. Capecitabine-induced diarrhea secondary to ileitis is a severe adverse drug event, which occurs during adjuvant chemotherapy and does not respond to conservative treatment with antidiarrheals, often necessitating permanent drug withdrawal. A high index of suspicion is critical as the complications, such as dehydration and the associated electrolyte derangements, may be life-threatening if diagnosis and cause-specific treatment are delayed.
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Affiliation(s)
- Artsiom Klimko
- Division of Physiology and Neuroscience, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Cristian G Tieranu
- Gastroenterology, "Elias" Emergency University Hospital, Bucharest, ROU.,Gastroenterology, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Andrei O Olteanu
- Gastroenterology, "Elias" Emergency University Hospital, Bucharest, ROU
| | - Carmen M Preda
- Gastroenterology, Fundeni Clinical Institute, Bucharest, ROU.,Gastroenterology, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Elena M Ionescu
- Gastroenterology, "Elias" Emergency University Hospital, Bucharest, ROU.,Gastroenterology, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
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7
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Andreyev HJN, Lalji A, Mohammed K, Muls ACG, Watkins D, Rao S, Starling N, Chau I, Cruse S, Pitkaaho V, Matthews J, Caley L, Pittordou V, Adams C, Wedlake L. The FOCCUS study: a prospective evaluation of the frequency, severity and treatable causes of gastrointestinal symptoms during and after chemotherapy. Support Care Cancer 2021; 29:1443-1453. [PMID: 32676853 PMCID: PMC7843552 DOI: 10.1007/s00520-020-05610-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/29/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The underlying mechanisms of chemotherapy-induced gastrointestinal (GI) symptoms are poorly researched. This study characterised the nature, frequency, severity and treatable causes for GI symptoms prospectively in patients undergoing chemotherapy for GI malignancy. METHODS Patients receiving chemotherapy for a GI malignancy were assessed pre-chemotherapy, then monthly for 1 year using the Gastrointestinal Symptom Rating Scale, a validated patient-reported outcome measure. Patients with new, troublesome GI symptoms were offered investigations to diagnose the cause(s). Their oncologist was alerted when investigations were abnormal. RESULTS A total of 241 patients, 60% male, median age 63 years (range 30-88), were enrolled; 122 patients were withdrawn, 93%, because of progressive disease or death. During the study, > 20% patients reported chronic faecal incontinence and > 10% reported moderate or severe problems with taste, dysphagia, belching, heartburn, early satiety, appetite, nausea, abdominal cramps, peri-rectal pain, rectal flatulence, borborygmi, urgency of defecation or tenesmus. Thirty percent reported continuing passage of hard stools and 30% on-going diarrhoea. Moderate or severe fatigue affected 40% participants at its peak and persisted in 15% at 1 year. Toxicity dictated change in chemotherapy for 13-29% patients/month. Common Terminology Criteria for Adverse Events underestimated gastrointestinal morbidity. Pre-chemotherapy screening identified previously undiagnosed pathology: exocrine pancreatic insufficiency (9%), vitamin B12 deficiency (12%) and thyroid dysfunction (20%). Patients often refused investigations to diagnose their chemotherapy-induced symptoms; however, for every three investigations performed, one treatable cause was diagnosed: particularly small intestinal bacterial overgrowth (54%), bile acid malabsorption (43%), previously not described after chemotherapy, and unsuspected urinary tract infection (17%). CONCLUSIONS Patients undergoing chemotherapy for GI malignancy commonly have difficult GI symptoms requiring active management which does not occur routinely. The underlying causes for these symptoms are often treatable or curable. Randomised trials are urgently needed to show whether timely investigation and treatment of symptoms improve quality of life and survival. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02121626.
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Affiliation(s)
- H Jervoise N Andreyev
- The Department of Gastroenterology, Lincoln County Hospital, United Lincolnshire Hospitals Trust, Greetwell Rd, Lincoln, LN2 5PT, UK.
- The Biomedical Research Centre, Nottingham Digestive Diseases Centre, The School of Medicine, University of Nottingham, Nottingham, UK.
| | - Amyn Lalji
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Kabir Mohammed
- Clinical Research and Development Department, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Ann C G Muls
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - David Watkins
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Sheela Rao
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Naureen Starling
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Ian Chau
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Sarah Cruse
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Ville Pitkaaho
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Jennifer Matthews
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Laura Caley
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Victoria Pittordou
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Carolyn Adams
- The Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Linda Wedlake
- Royal Marsden Clinical Trials Unit Royal Marsden NHS Foundation Trust, Sutton, UK
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8
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Schlager L, Wöran K, Luhn H, Stift A, Harpain F. A Case Report of Capecitabine-Associated Bowel Inflammation With a Novel Mutation of the DPYD Gene. AJSP: REVIEWS AND REPORTS 2020; 25:e8-e12. [DOI: 10.1097/pcr.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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9
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Scarpignato C, Bjarnason I. Drug-Induced Small Bowel Injury: a Challenging and Often Forgotten Clinical Condition. Curr Gastroenterol Rep 2019; 21:55. [PMID: 31720893 DOI: 10.1007/s11894-019-0726-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Most drugs are given by the oral route. Oral intake allows direct contact between the drug and the entire GI tract mucosa, exposing it to potential topical damage until absorption. Medication-induced GI symptoms and lesions are therefore commonly encountered in clinical practice. This review will examine the most common drugs or classes of drugs affecting small bowel function and/or structure. RECENT FINDINGS Since non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medicines, NSAID enteropathy is highly prevalent and brings about considerable morbidity. Antimicrobials and proton-pump inhibitors profoundly modify intestinal microbiota, affecting gut sensory and motor functions, while other drugs (like iron and gold derivatives) impair intestinal permeability. Olmesartan (and likely ACE inhibitors) induce villous atrophy and consequent malabsorption. Mycophenolate mofetil, cancer chemotherapeutic agents, and immune checkpoint inhibitors cause intestinal inflammation, abdominal pain, and diarrhea. Potassium chloride supplements may induce small bowel ulceration, stenosis, and perforation while the cotraceptive pill and anticoagulants are associated with intestinal ischemia and spontaneous intramural hematoma, respectively. In clinical practice, a deep knowledge of clinical pharmacology and toxicology and a high degree of suspicion of drug-related adverse events are mandatory. Only then, the practicing physician will be able to diagnose medication-induced small bowel lesions correctly and will implement the best strategies to treat them.
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Affiliation(s)
- Carmelo Scarpignato
- LUdeS Lugano Campus, Lugano, Switzerland.
- United Campus of Malta, Gzira, Malta.
- Faculty of Medicine, Chinese University of Hong Kong, ShaTin, Hong Kong.
- Department of Medicine & Surgery, University of Parma, Parma, Italy.
| | - Ingvar Bjarnason
- Department of Gastroenterology, King's College Hospital, London, UK
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10
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Khan T, Mujtaba M, Flores MS, Nahum K, Carson MP. A Case of Pneumatosis Intestinalis With Pneumoperitoneum as a Potential Delayed Adverse Effect of Capecitabine. World J Oncol 2019; 10:151-152. [PMID: 31312282 PMCID: PMC6615914 DOI: 10.14740/wjon1186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/18/2019] [Indexed: 12/02/2022] Open
Abstract
Ileitis and colitis are known complications of capecitabine when used in patients with gastrointestinal cancers. However, to our knowledge, pneumatosis intestinalis (PI) has not previously been reported with this medication. We present a patient with breast cancer, without any metastases to the gastrointestinal tract, who presented with persistent diarrhea 4 weeks after discontinuing adjuvant capecitabine, which was found to be due to PI. As she had no other risk factors or identifiable causes, her PI was attributed to a delayed reaction to capecitabine. This case highlights the need to consider PI earlier in the differential diagnosis in patients with breast cancer who present with unexplained diarrhea after recent discontinuation of capecitabine.
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Affiliation(s)
- Taimoor Khan
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Mohamed Mujtaba
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Marcus S Flores
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Kenneth Nahum
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Michael P Carson
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
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11
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Dao AE, Hsu A, Nakshabandi A, Mandaliya R, Nadella S, Sivaraman A, Mattar M, Charabaty A. Role of colonoscopy in diagnosis of capecitabine associated ileitis: Two case reports. World J Gastrointest Endosc 2019; 11:383-388. [PMID: 31205599 PMCID: PMC6556489 DOI: 10.4253/wjge.v11.i5.383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Capecitabine is considered a first line agent in adjuvant therapy for breast and colorectal cancer. However, cases of severe diarrhea have been reported with increasing frequency in recent years. When diarrhea is severe and prolonged, capecitabine associated ileitis should be considered as a possible etiology.
CASE SUMMARY Herein, we present two cases of capecitabine ileitis, specifically involving the terminal ileum and ascending colon. We will demonstrate the disease course and treatment modalities applied to alleviate this condition, as well as discuss the merits of using colonoscopy to aid in diagnosis.
CONCLUSION Ultimately our cases demonstrate that symptomatic management with traditional anti-diarrheal medications is largely ineffective. Prompt recognition and discontinuation of capecitabine is an imperative step in proper management of this condition and colonoscopy with biopsy can be helpful when the diagnosis is unclear.
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Affiliation(s)
- Alexander E Dao
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Angela Hsu
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Ahmad Nakshabandi
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Rohan Mandaliya
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Sandeep Nadella
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Anita Sivaraman
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Mark Mattar
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Aline Charabaty
- Department of Gastroenterology, Johns Hopkins University at Sibley Memorial Hospital, Washington, DC 20016, United States
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Almagro Casado E, Gutierrez L, Sánchez Ruiz A, Ruiz Casado A. Chemotherapy-induced enteritis: Institutional experience and review of the literature. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Almagro Casado E, Gutierrez L, Sánchez Ruiz A, Ruiz Casado A. Enteritis inducida por quimioterapia: experiencia institucional y revisión bibliográfica. Rev Clin Esp 2019; 219:165-167. [DOI: 10.1016/j.rce.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/07/2018] [Indexed: 10/27/2022]
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Two Cases of Capecitabine-Induced Ileitis in Patients Treated with Radiochemotherapy to the Pelvis and Review of the Literature. J Gastrointest Cancer 2019; 49:538-542. [PMID: 28547118 DOI: 10.1007/s12029-017-9955-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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van Hellemond IEG, Thijs AM, Creemers GJ. Capecitabine-Associated Terminal Ileitis. Case Rep Oncol 2018; 11:654-659. [PMID: 30483093 PMCID: PMC6243901 DOI: 10.1159/000492781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 12/21/2022] Open
Abstract
Capecitabine is an oral fluoropyrimidine used as adjuvant and palliative chemotherapy in patients with colorectal cancer. Diarrhea is a well-known side effect of capecitabine and 5-fluorouracil agents. We present a case with terminal ileitis as a rare adverse event of capecitabine treatment. Capecitabine-induced terminal ileitis is likely to be underreported. It should be considered more often as a cause of severe and atypical complaints of diarrhea during treatment with capecitabine or other 5-fluorouracil agents.
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Affiliation(s)
| | - Annemarie M Thijs
- Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Geert-Jan Creemers
- Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands
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Small Bowel Lesions Mimicking Crohn's Disease. Curr Gastroenterol Rep 2018; 20:43. [PMID: 30079433 DOI: 10.1007/s11894-018-0651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Not all injuries of the terminal ileum are Crohn's disease. It is the purpose of this review to consider the differential diagnosis of other acute and chronic ileal lesions. RECENT FINDINGS The recognition of a granulomatous disease of the terminal ileum, distinct from tuberculosis, dates back over 85 years and perhaps much farther, but over the past decades, many other clinical pathologic entities have been described that are neither tuberculosis nor Crohn's eponymous regional enteritis. In recent years, the catalog of lesions mimicking Crohn's disease of the small bowel and proposals for differential diagnosis and treatment have expanded to include newly reported appendiceal pathology, primary cancers and lymphomas of the intestine, unexpected metastases from distant organs, unusual infections, vasculitides and other ischemic conditions, Behçet's disease, endometriosis, and drug reactions. A diagnosis of Crohn's disease should not be a reflex action in the face of small bowel structural or inflammatory lesions without consideration of pathology in adjacent organs, primary and metastatic lesions of the small intestine, infections, vascular diseases, infiltrative diseases, drug injury, or other "idiopathic" conditions.
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