Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer.
Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer.
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DOI：
10.1136/gutjnl-2011-300563
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发表时间：
2012-02
期刊：
影响因子：
24.5
通讯作者：
Faculty of Clinical Oncology Section of the Royal College of Radiologists
中科院分区：
文献类型：
--
作者：
Andreyev HJ;Davidson SE;Gillespie C;Allum WH;Swarbrick E;British Society of Gastroenterology;Association of Colo-Proctology of Great Britain and Ireland;Association of Upper Gastrointestinal Surgeons;Faculty of Clinical Oncology Section of the Royal College of Radiologists
癌症治疗后出现对生活质量产生中度或重度影响的慢性胃肠道 (GI) 症状的患者人数与每年诊断为炎症性肠病的人数相似。然而，与炎症性肠病患者相比，大多数患者没有转诊进行胃肠病学评估。接诊这些患者的临床医生通常不知道针对性检查的好处（与排除复发性癌症所需的检查不同）、可用治疗的范围以及癌症治疗副作用背后的病理过程与良性胃肠道疾病的病理过程有何不同。本文旨在帮助临床医生认识到这个问题，并提出管理各种综合症的方法。我们进行了多学科文献综述，以制定指导意见，以促进癌症治疗胃肠道副作用的临床管理。胃肠道内不同的病理过程可能会产生相同的症状。最佳管理需要适当的调查和协调的多学科工作。化疗期间或化疗后经常出现乳糖不耐受、小肠细菌过度生长和胆汁酸吸收不良。毒素阴性艰难梭菌和巨细胞病毒感染在免疫抑制患者中可能是暴发性的，需要快速诊断和治疗。肝脏副作用包括病毒性肝炎重新激活、肝窦阻塞综合征、脂肪变性和脂肪性肝炎。抗癌生物制剂与常规药物存在多种相互作用。中性粒细胞减少性小肠结肠炎禁用结肠镜检查，但内镜检查对于其他胃肠道出血患者可能可以挽救生命。癌症治疗后，通过简单的问题就可以确定需要转诊接受胃肠道症状专家治疗的患者。其他棘手的骨盆问题（例如泌尿、性、营养）也很常见，也可能需要专家的帮助。受慢性胃肠道症状影响的最大群体是那些接受过盆腔放射治疗的患者。它们的复杂症状通常由不止一种诊断引起，当经验治疗失败时，需要胃肠病学家进行系统调查。放疗后的所有内窥镜和外科手术都有潜在危险，因为放疗可能会引起严重的局部缺血。目前有效治疗放射引起的胃肠道出血的最佳证据是硫糖铝灌肠和高压氧治疗。所有癌症科室都必须开发简单的方法来识别许多需要帮助的患者，并建立常规转诊途径到专业胃肠病学家那里，患者可以接受安全有效的治疗。尽早与肿瘤科医生和/或专科医生联系并听取患者家人和朋友的意见通常有助于胃肠病学家完善治疗策略。需要加强对癌症治疗后期影响的培训。
The number of patients with chronic gastrointestinal (GI) symptoms after cancer therapies which have a moderate or severe impact on quality of life is similar to the number diagnosed with inflammatory bowel disease annually. However, in contrast to patients with inflammatory bowel disease, most of these patients are not referred for gastroenterological assessment. Clinicians who do see these patients are often unaware of the benefits of targeted investigation (which differ from those required to exclude recurrent cancer), the range of available treatments and how the pathological processes underlying side effects of cancer treatment differ from those in benign GI disorders. This paper aims to help clinicians become aware of the problem and suggests ways in which the panoply of syndromes can be managed. A multidisciplinary literature review was performed to develop guidance to facilitate clinical management of GI side effects of cancer treatments. Different pathological processes within the GI tract may produce identical symptoms. Optimal management requires appropriate investigations and coordinated multidisciplinary working. Lactose intolerance, small bowel bacterial overgrowth and bile acid malabsorption frequently develop during or after chemotherapy. Toxin-negative Clostridium difficile and cytomegalovirus infection may be fulminant in immunosuppressed patients and require rapid diagnosis and treatment. Hepatic side effects include reactivation of viral hepatitis, sinusoidal obstruction syndrome, steatosis and steatohepatitis. Anticancer biological agents have multiple interactions with conventional drugs. Colonoscopy is contraindicated in neutropenic enterocolitis but endoscopy may be life-saving in other patients with GI bleeding. After cancer treatment, simple questions can identify patients who need referral for specialist management of GI symptoms. Other troublesome pelvic problems (eg, urinary, sexual, nutritional) are frequent and may also require specialist input. The largest group of patients affected by chronic GI symptoms are those who have been treated with pelvic radiotherapy. Their complex symptoms, often caused by more than one diagnosis, need systematic investigation by gastroenterologists when empirical treatments fail. All endoscopic and surgical interventions after radiotherapy are potentially hazardous as radiotherapy may induce significant local ischaemia. The best current evidence for effective treatment of radiation-induced GI bleeding is with sucralfate enemas and hyperbaric oxygen therapy. All cancer units must develop simple methods to identify the many patients who need help and establish routine referral pathways to specialist gastroenterologists where patients can receive safe and effective treatment. Early contact with oncologists and/or specialist surgeons with input from the patient's family and friends often helps the gastroenterologist to refine management strategies. Increased training in the late effects of cancer treatment is required.
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影响因子：
8.4
作者：
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通讯作者：
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影响因子：
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DOI：
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发表时间：
2008-09-01
影响因子：
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影响因子：
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