Neutropenic enterocolitis. Clinical diagnosis and treatment

Wade, David S.; Nava, Hector; Douglass, Harold O.

doi:10.1002/1097-0142(19920101)69:1<17::aid-cncr2820690106>3.0.co;2-x

Cited by 181 publications

(113 citation statements)

References 30 publications

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“…A review of the literature reveals that diarrhea and neutropenic enterocolitis are the two major clinical complications in this field. [4][5][6][7][8][9][10][11] Where specified, definitions of diarrhea vary only slightly across trials, usually requiring at least three or four unformed stools within 24 h. [4][5][6][7][8][9][10][11][12] Clostridium difficile (C. difficile) has frequently been identified as the causative pathogen, with reported incidence rates ranging from 4.8-9% in patients with acute myelogenous leukemia, from 4.9-7.5% in patients undergoing autologous stem cell transplantation and from [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].4% in those undergoing allogeneic stem cell transplantation. 5,6,9,11,13,14 Other associated factors include prior use of antibiotics or certain antineoplastic agents, e.g.…”

Section: Introductionmentioning

confidence: 99%

“…12,18 Neutropenic enterocolitis has been associated with mortality rates of 50% and higher. 9,12,19,20 Incidence rates between 3.5 and 28% have been reported. 4,12,21 In a meta-analysis, a pooled incidence rate of 5.3% was calculated for patients with hematologic malignancies or receiving high-dose chemotherapy for solid tumors or aplastic anemia.…”

Section: Introductionmentioning

confidence: 99%

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Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients

Vehreschild

Meißner²,

Cornely³

et al. 2011

Haematologica

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BackgroundNeutropenic patients are at risk of abdominal complications and yet the incidence and impact of these complications on patients' morbidity and mortality have not been sufficiently evaluated. We aimed to assess a clinical rule for early detection of abdominal complications leading to death or transfer to intensive care in patients with chemotherapy-associated neutropenia. Design and MethodsThis observational multicenter study was carried out in seven German hematology-oncology departments. For inclusion, neutropenia of at least 5 consecutive days was required. Risk factors for "transfer to intensive care" and "death" were assessed by backward-stepwise binary logistic regression analyses. Chemotherapy-associated bowel syndrome was defined as a combination of fever (T ≥37.8 °C) and abdominal pain and/or lack of bowel movement for 72 hours or more. Five hundred and twenty-one neutropenic episodes were documented in 359 patients. ResultsThe incidence of chemotherapy-associated bowel syndrome was 126/359 (35%) in first episodes of neutropenia. Transfer to intensive care occurred in 41/359 (11%) and death occurred in 17/359 (5%) first episodes. Chemotherapy-associated bowel syndrome and duration of neutropenia were identified as risk factors for transfer to intensive care (P<0.001; OR 4.753; 95% CI 2.297-9.833, and P=0.003; OR 1.061/d; 95% CI 1.021-1.103). Chemotherapyassociated bowel syndrome and mitoxantrone administration were identified as risk factors for death (P=0.005; OR 4.611; 95% CI 1.573-13.515 and P=0.026; OR 3.628; 95% CI 1.169-11.256). ConclusionsThe occurrence of chemotherapy-associated bowel syndrome has a significant impact on patients' outcome. In future interventional clinical trials, this definition might be used as a selection criterion for early treatment of patients at risk of severe complications.Key words: neutropenia, chemotherapy-associated bowel syndrome, risk prediction.Citation: Vehreschild MJGT, Meißner AMK, Cornely OA, Maschmeyer G, Neumann S, von Lilienfeld-Toal M, Karthaus M, Wattad M, Staib P, Hellmich M, Christ H, and Vehreschild J-J. Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients

Vehreschild

Meißner²,

Cornely³

et al. 2011

Haematologica

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“…[1][2][3][4][5][6][7] Originally, the diagnosis of typhlitis hinged on the clinical triad of neutropenia, abdominal pain, and fever and was supported by indirect evidence of right colon inflammation as evidenced on plain radiography or barium enema. 1,8,9 Today, ultrasonography (US) and computed tomography (CT) scans allow direct visualization of the bowel wall and its surrounding mesentery.…”

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confidence: 99%

Typhlitis in childhood cancer

McCarville¹,

Adelman²,

Li³

et al. 2005

Cancer

119

103

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BACKGROUNDTyphlitis is increasingly recognized in children undergoing chemotherapy but is poorly characterized. The authors investigated the demographic, clinical, and imaging (ultrasonography and computed tomography [CT] scans) variables related to the diagnosis, risk, and outcome of typhlitis.METHODSThe authors reviewed the records of patients who had typhlitis (bowel wall thickness ≥ 0.3 cm plus clinical findings) during treatment at St. Jude Children's Research Hospital (Memphis, TN) between 1990 and 2001. They assessed whether duration of typhlitis was related to bowel wall thickness, extent of colonic involvement, ascites, demographics, primary diagnosis, symptoms of typhlitis, or duration of neutropenia. To identify risk factors for typhlitis, the authors compared the demographic data and previous drug therapy of 78 patients who had typhlitis and 1231 identically treated children who did not.RESULTSOf 3171 children, 83 (2.6%) developed typhlitis. Frequent symptoms were abdominal pain (91%), fever (84%), abdominal tenderness (82%), and diarrhea (72%). Twelve percent of the patients were not neutropenic. Duration of typhlitis was associated with bowel wall thickness measured by ultrasonography (n = 68; P = 0.05) but not CT scan (n = 48; P = 0.67) and was associated with duration of neutropenia (P = 0.02), fever (P = 0.01), and abdominal tenderness (P = 0.04). Age >16 years at cancer diagnosis was the only demographic factor associated with typhlitis (P = 0.03). Two patients died of typhlitis.CONCLUSIONSUltrasonography was a useful imaging modality for children with suspected typhlitis. The classic triad of abdominal pain, fever, and neutropenia may be absent. The severity of typhlitis was related to the duration of neutropenia and the presence of fever or abdominal tenderness. Cancer 2005. © 2005 American Cancer Society.

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“…31,36,37 Our findings that lower alimentary tract mucositis did not cause death or require surgical intervention stand in sharp contrast to the recent reports of 30% to 50% mortality. [38][39][40][41][42] This difference can be partly explained by the different definitions for lower alimentary tract mucositis, with some reports focusing on the most severe manifestations of lower alimentary tract mucositis only (neutropenic enterocolitis, typhlitis, or necrotizing enteropathy). 5 Although all lower alimentary tract mucositisrelated data were prospectively collected, our study suffers from the finding that lower alimentary tract mucositis was not the primary endpoint for Total Therapy 3 (which was myeloma outcomes), and hence additional studies focused on lower alimentary tract mucositis (such as measuring bowel wall thickness) were not performed.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for lower alimentary tract mucositis after 1529 courses of chemotherapy in a homogenous population of oncology patients

Krishna¹,

Zhao²,

Grazziutti³

et al. 2010

Cancer

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BACKGROUND:Lower alimentary tract mucositis is a serious complication of chemotherapy. The aim of the study was to determine the incidence, risk factors, and mortality of lower alimentary tract mucositis in a homogeneous population of patients with newly diagnosed myeloma receiving similar antineoplastic therapy and standardized supportive care. METHODS: Lower alimentary tract mucositis was evaluated among 303 consecutive patients with myeloma (2004)(2005)(2006)(2007) enrolled in a clinical trial consisting of induction chemotherapy, tandem melphalan-based autologous stem cell transplantation (ASCT), and consolidation. Lower alimentary tract mucositis was defined as neutropenia-associated grade II-IV enteritis/colitis. Pretreatment risk factors were examined including body surface area (BSA), serum albumin (albumin), and estimated creatinine clearance (CrCl). Multiple logistic regression model was used to compute adjusted odds ratio (OR) and 95% confidence intervals (CI). RESULTS: Forty-seven (15.5%) patients developed lower alimentary tract mucositis during 1529 courses of chemotherapy (including 536 melphalan-based ASCT). Pre-enrollment BSA <2 m 2 (OR, 2.768; 95% CI, 1.200-6.381; P ¼ .0169) increased the risk for lower alimentary

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Neutropenic enterocolitis. Clinical diagnosis and treatment

Cited by 181 publications

References 30 publications

Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients

Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients

Typhlitis in childhood cancer

Incidence and risk factors for lower alimentary tract mucositis after 1529 courses of chemotherapy in a homogenous population of oncology patients

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