Gastrointestinal Complications

 

Early onset <28 days

Management

GI mucositis

Chemotherapy/irradiation complicated by OVS or CoNS bacteraemia

Pain killers (morphine) and antibiotics

Oesophagitis

Chemotherapy

Antacids

Herpes simplex

Antiviral prophylaxis

Candida spp.

Antifungal therapy

Gastritis

Chemotherapy/irradiation

Antacids

Neutropenic enterocolitis

Multifactorial origin

Conservative approach

High risk of candidaemia and bacteraemia with Clostridia spp. and Staph. aureus

Broad antimicrobial coverage
 
late onset >28 days

Management

GI mucositis

GVHD high risk of invasive fungal diseases

Start corticosteroids antifungal therapy

Colitis

Clostridium difficile

Metronidazole

CMV, adenovirus, H1N1

Antiviral treatment

Other opportunistic pathogens:

Targeted therapy

Cryptosporidium spp.

Mucorales spp.

Nontuberculous mycobacteriae spp.





References



1.

Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J. Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol. 2006;24(27):4472–8.PubMedCrossRef


2.

Warr DG, Hesketh PJ, Gralla RJ, Muss HB, Herrstedt J, Eisenberg PD, et al. Efficacy and tolerability of aprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients with breast cancer after moderately emetogenic chemotherapy. J Clin Oncol. 2005;23(12):2822–30.PubMedCrossRef


3.

Warr DG, Grunberg SM, Gralla RJ, Hesketh PJ, Roila F, Wit R, et al. The oral NK(1) antagonist aprepitant for the prevention of acute and delayed chemotherapy-induced nausea and vomiting: pooled data from 2 randomised, double-blind, placebo controlled trials. Eur J Cancer. 2005;41(9):1278–85.PubMedCrossRef


4.

Lopez-Jimenez J, Martin-Ballesteros E, Sureda A, Uralburu C, Lorenzo I, del Campo R, et al. Chemotherapy-induced nausea and vomiting in acute leukemia and stem cell transplant patients: results of a multicenter, observational study. Haematologica. 2006;91(1):84–91.PubMed


5.

Kris MG, Hesketh PJ, Somerfield MR, Feyer P, Clark-Snow R, Koeller JM, et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol. 2006;24(18):2932–47.PubMedCrossRef


6.

Blijlevens NM, Donnelly JP, de Pauw BE. Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant. 2000;25(12):1269–78.PubMedCrossRef


7.

Sonis ST. The pathobiology of mucositis. Nat Rev Cancer. 2004;4(4):277–84.PubMedCrossRef


8.

Wardley AM, Jayson GC, Swindell R, Morgenstern GR, Chang J, Bloor R, et al. Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haematopoietic progenitor rescue. Br J Haematol. 2000;110(292):299.


9.

Jones JA, Avritscher EB, Cooksley CD, Michelet M, Bekele BN, Elting LS. Epidemiology of treatment-associated mucosal injury after treatment with newer regimens for lymphoma, breast, lung, or colorectal cancer. Support Care Cancer. 2006;14(6):505–15.PubMedCrossRef


10.

Blijlevens N, Schwenkglenks M, Bacon P, D’Addio A, Einsele H, Maertens J, et al. Prospective oral mucositis audit: oral mucositis in patients receiving high-dose melphalan or BEAM conditioning chemotherapy–European Blood and Marrow Transplantation Mucositis Advisory Group. J Clin Oncol. 2008;26(9):1519–25.PubMedCrossRef


11.

McCann S, Schwenkglenks M, Bacon P, Einsele H, D’Addio A, Maertens J, et al. The Prospective Oral Mucositis Audit: relationship of severe oral mucositis with clinical and medical resource use outcomes in patients receiving high-dose melphalan or BEAM-conditioning chemotherapy and autologous SCT. Bone Marrow Transplant. 2008;43:141–7.PubMedCrossRef

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Sep 20, 2016 | Posted by in HEMATOLOGY | Comments Off on Gastrointestinal Complications

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