Small intestinal mucosal injury in patients with gastrointestinal cancer who develop complicated fluoropyrimidine-induced diarrhea

Abstract Background: Diarrhea is a common adverse event of fluoropyrimidine-based chemotherapy. However, no treatment with promising evidence has been established for chemotherapy-induced diarrhea (CID); limited data are available on the frequency of complicated CID and small intestinal mucosal damage. In this current study, we aimed to determine the incidence of complicated CID and mucosal injury among patients with complicated CID receiving fluoropyrimidine via small bowel capsule endoscopy (CE). Methods: In total, 536 patients with advanced or recurrent gastrointestinal cancer who received fluoropyrimidine-based chemotherapy were retrospectively analyzed. Diarrhea was evaluated using the Common Terminology Criteria for Adverse Events version 4. Complicated CID was defined according to the American Society of Clinical Oncology guidelines. To evaluate small intestinal mucosal injury in patients with complicated CID, CE was performed. Multivariate analysis was performed to identify risk factors for complicated CID.Results: In total, 32 (6%) patients developed complicated CID. Complicating symptoms were noted in 24 (75%) patients, with cramping, vomiting, and sepsis being observed in 15 (63%), 8 (33%), and 2 (8%) patients, respectively. Among the 12 patients who underwent CE, 10 (83%) exhibited abnormal findings. Multivariate analysis showed that oral fluoropyrimidine administration was a risk factor for complicated CID (odds ratio, 2.95; 95% confidence interval, 1.06–8.19).Conclusions: Despite the relatively low incidence of complicated CID, most patients with complicated CID exhibited small intestinal mucosal injury, with some developing fever or sepsis as complications. Thus, bacterial translocation secondary to small intestinal mucosal injury should be considered in the management of patients with complicated fluoropyrimidine-induced diarrhea.

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Small intestinal mucosal injury and its risk factors in patients with gastrointestinal cancer who developed complicated fluoropyrimidine-induced diarrhea

BMC Gastroenterology ◽

10.1186/s12876-020-01507-5 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Miho Sakumura ◽

Takayuki Ando ◽

Ayumu Hosokawa ◽

Takahiko Nakajima ◽

Iori Motoo ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Gastrointestinal Cancer ◽

Mucosal Injury ◽

Common Adverse Event ◽

Baseline Risk ◽

Oral Fluoropyrimidine ◽

Intestinal Mucosal Injury ◽

Small Intestinal

Abstract Background Diarrhea is a common adverse event of fluoropyrimidine-based chemotherapy. However, limited data are available on the frequency and risk factors of complicated chemotherapy-induced diarrhea (CID) and small intestinal mucosal damage. In this current study, we aimed to determine the incidence of complicated CID and mucosal injury among patients with complicated CID receiving fluoropyrimidine via small bowel capsule endoscopy (CE) and determined baseline risk factors associated with complicated CID. Methods In total, 536 patients with advanced or recurrent gastrointestinal cancer who received fluoropyrimidine-based chemotherapy were retrospectively analyzed. Diarrhea was evaluated using the Common Terminology Criteria for Adverse Events version 4. Complicated CID was defined according to the American Society of Clinical Oncology guidelines. To evaluate small intestinal mucosal injury in patients with complicated CID, CE was performed. Multivariate analysis was performed to identify risk factors for complicated CID. Results Total number of 32 (6%) patients developed complicated CID. Complicating symptoms were noted in 25 (78%) patients, with cramping, vomiting, and sepsis being observed in 15 (60%), 8 (32%), and 3 (12%) patients, respectively. Among the 13 patients who underwent CE, 11 (85%) showed abnormal findings. Multivariate analysis revealed that oral fluoropyrimidine administration was a risk factor for complicated CID (odds ratio 2.95; 95% confidence interval 1.06–8.19). Conclusions Despite the relatively low incidence of complicated CID, mucosal injury of small intestine was common in patients with complicated fluoropyrimidine-induced diarrhea and oral fluoropyrimidine was an independent risk factor.

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Small intestinal mucosal injury and its risk factors in patients with gastrointestinal cancer who developed complicated fluoropyrimidine-induced diarrhea

10.21203/rs.2.24610/v2 ◽

2020 ◽

Author(s):

Miho Sakumura ◽

Takayuki Ando ◽

Ayumu Hosokawa ◽

Takahiko Nakajima ◽

Iori Motoo ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Gastrointestinal Cancer ◽

Mucosal Injury ◽

Common Adverse Event ◽

Baseline Risk ◽

Oral Fluoropyrimidine ◽

Intestinal Mucosal Injury ◽

Small Intestinal

Abstract Background: Diarrhea is a common adverse event of fluoropyrimidine-based chemotherapy. However, limited data are available on the frequency and risk factors of complicated chemotherapy-induced diarrhea (CID) and small intestinal mucosal damage. In this current study, we aimed to determine the incidence of complicated CID and mucosal injury among patients with complicated CID receiving fluoropyrimidine via small bowel capsule endoscopy (CE) and determined baseline risk factors associated with complicated CID.Methods: In total, 536 patients with advanced or recurrent gastrointestinal cancer who received fluoropyrimidine-based chemotherapy were retrospectively analyzed. Diarrhea was evaluated using the Common Terminology Criteria for Adverse Events version 4. Complicated CID was defined according to the American Society of Clinical Oncology guidelines. To evaluate small intestinal mucosal injury in patients with complicated CID, CE was performed. Multivariate analysis was performed to identify risk factors for complicated CID.Results: Total number of 32 (6%) patients developed complicated CID. Complicating symptoms were noted in 25 (78%) patients, with cramping, vomiting, and sepsis being observed in 15 (60%), 8 (32%), and 3 (12%) patients, respectively. Among the 13 patients who underwent CE, 11 (85%) showed abnormal findings. Multivariate analysis revealed that oral fluoropyrimidine administration was a risk factor for complicated CID (odds ratio, 2.95; 95% confidence interval, 1.06–8.19).Conclusions: Despite the relatively low incidence of complicated CID, mucosal injury of small intestine was common in patients with complicated fluoropyrimidine-induced diarrhea and oral fluoropyrimidine was an independent risk factor.

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Effect of Weikang Capsule (胃康胶囊) on Aspirin-Related Gastric and Small Intestinal Mucosal Injury

Chinese Journal of Integrative Medicine ◽

10.1007/s11655-021-3300-2 ◽

2021 ◽

Author(s):

Lin Du ◽

Feng Gao ◽

Jie Zhang

Keyword(s):

Mucosal Injury ◽

Intestinal Mucosal Injury ◽

Small Intestinal

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Influence of Helicobacter pylori Infection on the Small Intestinal Mucosa

ISRN Endoscopy ◽

10.5402/2013/408931 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Mitsunori Maeda ◽

Masakazu Nakano ◽

Hideyuki Hiraishi

Keyword(s):

Helicobacter Pylori ◽

Negative Relationship ◽

Mucosal Injury ◽

Enzyme Linked Immunosorbent Assay ◽

Small Intestinal Mucosa ◽

Significant Negative Relationship ◽

Positive Rate ◽

Intestinal Mucosal Injury ◽

Small Intestinal ◽

H Pylori

Background/Aims. To investigate the role of Helicobacter pylori infection in the development of enteritis (small intestinal mucosal injury). Methodology. Between April 2007 and January 2013, 99 patients undergoing capsule endoscopy (CE) were tested for anti-H. pylori immunoglobulin G antibody (Hp-IgG) using an enzyme-linked immunosorbent assay (ELISA). None of the patients had been treated for H. pylori infection or diagnosed as having Crohn’s disease or any other clinically apparent small intestinal disorders prior to the CE. Results. The overall Hp-IgG-positive rate was 26.3%. The incidence of enteritis, as diagnosed by CE, tended to be lower in the Hp-IgG-positive patients (23.1%) than in the Hp-IgG-negative patients (38.4%) (). When patients receiving aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), well-known causes of enteritis, were excluded, the incidence of enteritis in the Hp-IgG-positive patients (11.7%) was significantly lower than that in the Hp-IgG-negative patients (43.7%) (). A binomial logistic regression analysis revealed a significant negative relationship between Hp-IgG positivity and the presence of enteritis in patients receiving neither aspirin nor NSAIDs (). Conclusions. Our data indicated that H. pylori positivity was inversely associated with the prevalence of enteritis.

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Extent and Duration of Small Intestinal Mucosal Injury in Intractable Diarrhea of Infancy

PEDIATRICS ◽

10.1542/peds.66.5.730 ◽

1980 ◽

Vol 66 (5) ◽

pp. 730-735

Author(s):

Thomas M. Rossi ◽

Emanuel Lebenthal ◽

Kenneth S. Nord ◽

Rafiqua R. Fazili

Keyword(s):

Elemental Diet ◽

Mucosal Injury ◽

Height Velocity ◽

Common Finding ◽

Small Intestinal Mucosa ◽

Intractable Diarrhea ◽

Young Infants ◽

Intestinal Mucosal Injury ◽

Small Intestinal

Thirty infants with intractable diarrhea of infancy (IDI) underwent small bowel biopsies in order to determine the extent and duration of small intestinal mucosal injury. The onset of the persistent diarrhea occurred prior to 3 months of age and continued for an average of 48 days prior to investigation. In 18 cases, no associated entities were found. Mucosal injury was invariably found in all 30 infants: grade IV injury in 11, grade III in eight, grade II in nine, and grade I atrophy in one. Disaccharidase activities were diminished and corresponded to the degree of atrophy. Lactase activity was diminished to a greater extent than sucrase and maltase. Significant, persistent mucosal injury existed for an average of six months in 16 of the 23 (70%) repeat biopsies. All infants were given an elemental diet (ED). Twelve of the 30 infants required parenteral nutrition (PN). These infants were gradually advanced to an oral elemental diet and maintained on this diet until histologic findings and disaccharidase levels were normal. Eighteen infants were fed and maintained on an elemental diet by mouth from time of admission until normal histologic findings and disaccharidases were found. No mortality occurred during management and follow-up. Twenty-two of the 28 infants in whom follow-up growth data were available excelled in weight and height velocity. The data suggest that prolonged injury to the small intestinal mucosa is a common finding in many cases of intractable diarrhea of infancy. Elemental diets should be started early in the course of protracted diarrhea in young infants, and may need to be continued for several months since histologic and enzymatic changes of the small intestine may persist for extended periods.

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