Gastroparesis as a significant gastrointestinal adverse event during intensive chemotherapy for solid caner: a case report

Abstract

Background Proper management of chemotherapy-related gastrointestinal toxicities is essential to maximize therapeutic outcome for malignancies. Gastroparesis is an onerous syndrome characterized by delayed gastric emptying without gastrointestinal obstruction, but this has not been recognized as chemotherapy-related complication in solid malignancies. Here, we describe a case of gastroparesis possibly caused by neurotoxicity of taxane and platinum-based high-intensity chemotherapy against solid cancer. Case Description A 73-year-old male was diagnosed with stage IVA oropharyngeal cancer (cT4N2bM0) as a cause of swallowing difficulty. As a curative treatment of the oropharyngeal cancer, induction chemotherapy with the regimen of docetaxel, cisplatin and fluorouracil (TPF) was initiated with nutritional support by nasogastric tube feeding. Then, this case was complicated with late-onset gastric dysmotility as evidenced by abnormally dilated stomach even after cessation of feeding for more than a few days. After a careful exclusion of other diseases that could cause gastric dysmotility, we eventually diagnosed chemotherapy-induced gastroparesis as a cause of his symptom. Notably, this refractory gastroparesis was successfully controlled with 5-HT4 agonist, mosapride, resulting in recovery of gastric motility and safe completion of the subsequent curative treatment. Conclusions Despite its rarity in patients with solid cancers, it is important to note chemotherapy-induced gastroparesis because delay in its management can be detrimental to their survival outcome. Thus, oncologists should consider gastroparesis in evaluating persistent upper abdominal symptoms after neurotoxic chemotherapies for solid cancer.

The prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma

“…The persistent contraction of the LES can be a consequence of radiation-induced injury to the vagus nerves 80 and/or chemotherapeutic drug-induced injury to the neurons of the myenteric plexus, which controls the motility of the digestive tract. 81,82 Vitton et al reported that 12 (60%) out of 20 patients with symptoms of dysphagia and history of cancers receiving radiotherapy or chemoradiotherapy to the cervical or thoracic esophagus had an abnormal pattern on EHRIM in which 1 (5%) patient was confirmed to have type II achalasia. 83 However, one of the pitfalls of their study was the lack of a control group to demonstrate the esophageal motility status in the non-irradiated subjects with matching age and sex.…”

“…The neurons of the ENS that control motility and peristalsis are located in the myenteric plexus, which lies between the circular and longitudinal layers of smooth muscles. The persistent contraction of the LES can be a consequence of radiation‐induced injury to the vagus nerves 80 and/or chemotherapeutic drug‐induced injury to the neurons of the myenteric plexus, which controls the motility of the digestive tract 81,82 . Vitton et al reported that 12 (60%) out of 20 patients with symptoms of dysphagia and history of cancers receiving radiotherapy or chemoradiotherapy to the cervical or thoracic esophagus had an abnormal pattern on EHRIM in which 1 (5%) patient was confirmed to have type II achalasia 83 .…”