Role of colonoscopy in diagnosis of capecitabine associated ileitis: Two case reports

Dao, Alexander; Hsu, Angela; Nakshabandi, Ahmad; Mandaliya, Rohan; Nadella, Sandeep; Sivaraman, Anita; Mattar, Mark; Charabaty, Aline

doi:10.4253/wjge.v11.i5.383

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…We are presenting the first case report of surgery specimen assisted diagnosis of this condition in combination with colonoscopy and CT scan (Table 1 ). Our analysis, together with previous literature [ 5 – 12 ], demonstrates that mucosal erosion and ulceration with acute as well as chronic inflammation are commonly seen in capecitabine associated ileitis. Another chemotherapeutic agent in the XELOX regimen is oxaliplatin, and bloody diarrhea caused by this drug is also rare.…”

Section: Discussionsupporting

confidence: 74%

“…Injury of the intestinal mucosa and subsequent enterocolitis induced by chemotherapy appeared to be the main contributing factor for the bleeding. A search of PubMed found only 11 published cases describing capecitabine treatment-related ileitis, and only 1 of these cases documents bloody diarrhea after capecitabine administration [ 5 ]. We are presenting the first case report of surgery specimen assisted diagnosis of this condition in combination with colonoscopy and CT scan (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, severe gastrointestinal bleeding due to enterocolitis induced by capecitabine is rare. To date, only 11 published cases described capecitabine treatment-related ileitis, and only 1 of these cases documents bloody diarrhea after capecitabine administration [ 5 ]. However, the ileitis diagnosed in these studies is through computed tomography (CT) scan or colonoscopy.…”

Section: Introductionmentioning

confidence: 99%

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Severe ileum bleeding following adjuvant capecitabine chemotherapy for locally advanced colon cancer: a case report and review of the literature

Zhang

Liu

et al. 2021

World J Surg Onc

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Background Capecitabine is a prodrug that is enzymatically converted to its active form, fluorouracil (also called 5-fluorouracil), which is commonly used as adjuvant chemotherapy in colorectal cancer patients. Severe gastrointestinal bleeding induced by capecitabine is rare. Here, we are presenting the first case report of surgery specimen assisted diagnosis of this uncommon condition. Case presentation A 63-year-old Chinese male with a history of colon adenocarcinoma and right hemicolectomy presented with severe lower gastrointestinal bleeding 2 days after finishing capecitabine administration during the first cycle of XELOX adjuvant chemotherapy. Because of the negative findings of active bleeding points by digital subtraction angiography (DSA) or colonoscopy, emergency laparotomy and partial enterectomy were performed. The bloody diarrhea had resolved after surgery and a terminal ileitis was diagnosed after pathological examination of the surgical specimen. Conclusions Terminal ileitis induced by capecitabine is likely to be underreported. It should be considered more often as a cause of severe gastrointestinal bleeding during or after treatment with capecitabine agents. Emergency surgery may achieve satisfactory outcomes if endoscopic hemostasis is ineffective. Highlights of this case 1. Gastrointestinal bleeding following capecitabine treatment in colorectal cancer patients might be life-threatening. 2. Terminal ileitis induced by capecitabine should always be considered in the differential diagnosis of severe gastrointestinal bleeding. 3. Awareness of the risk factors such as deficiency of dihydropyrimidine dehydrogenase, advanced age, or right colectomy may aid in reducing capecitabine-related morbidity. 4. When severe bleeding occurs, emergency surgery may achieve satisfactory outcomes if medical and endoscopic interventions are ineffective.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe ileum bleeding following adjuvant capecitabine chemotherapy for locally advanced colon cancer: a case report and review of the literature

Zhang

Liu

et al. 2021

World J Surg Onc

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“…Because these patients have many explanations for diarrhea, one of the greatest clinical problems in managing cancer patients with positive Clostridium difficile testing is establishing whether the positive results represent colonization or actual disease. Colonoscopy with biopsy has been indicated as a standardized diagnostic measure in patients on capecitabine with diarrhea refractory to conservative methods [ 15 ]. Capecitabine-associated ileitis tends to localize in the terminal ileum [ 16 ] with a granular erythematous appearance of mucosa with ulcerations.…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile Infection During Palliative Capecitabine Chemotherapy: A Case Report

Bhattar¹,

Agrawal²

2022

Cureus

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Capecitabine has been used for triple-negative metastatic breast cancers both as monotherapy and in combination with other agents. However, its gastrointestinal side effects are one of the biggest challenges for its patient compliance, and often result in permanent drug withdrawal. There have been reports of it causing enterocolitis (mainly terminal ileitis) and even ischaemic colitis, but it has not frequently been directly associated with Clostridium difficile infection. We describe a case of a 65-year-old woman with triplenegative breast cancer on palliative capecitabine who presented with blood-streaked watery diarrhea and abdominal pain and was diagnosed with chemotherapy-induced severe colitis with superimposed Clostridium difficile infection.

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“…3 Though adverse GI effects have been well-characterized clinically, description of the associated histopathologic features is limited and largely restricted to isolated case reports. [4][5][6][7][8][9][10][11][12][13][14][15][16] The current study, the largest series to date, characterizes the histopathologic features associated with capecitabine injury in GI mucosal biopsies.…”

mentioning

confidence: 97%

Capecitabine-induced Gastrointestinal Injury Shows a Graft-Versus-Host Disease (GVHD)-like Pattern

Ojukwu¹,

Cox²,

Larson³

et al. 2023

American Journal of Surgical Pathology

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Capecitabine is a commonly used oral chemotherapeutic agent. Gastrointestinal (GI) side effects are clinically well-known, however, the histopathologic changes have not been comprehensively studied. This study describes the largest case series (8 patients) characterizing the histopathology of capecitabine-induced GI injury. All patients were adults (median age: 64.5 y, range: 61 to 76 y) and there was gender parity. Patients were receiving treatment for malignancies of the colorectum (n=5), breast (n=1), pancreas (n=1), and appendix (n=1). All had GI symptoms, including 7 with diarrhea and abdominal pain and 1 with melena. Five of 8 (63%) showed graft-versus-host disease (GVHD)-like histologic changes in small intestinal and/or colonic biopsies characterized by crypt disarray and dropout, crypt atrophy, dilated crypts lined by attenuated epithelium, and increased crypt apoptosis. Neuroendocrine cell aggregates were present in 4 of 5 cases. Four of 5 showed patchy prominence in lamina propria eosinophils. One patient receiving concomitant radiation therapy had a small intestinal biopsy showing regenerative changes. Two patients had histologically unremarkable biopsies. On follow-up, capecitabine was discontinued or dose-reduced in all patients. Three of 5 patients with a GVHD-like pattern had clinical improvement, whereas 2 died shortly after biopsy. One with regenerative changes also had radiation dose reduction and improved clinically. Two with unremarkable biopsies improved symptomatically. In summary, capecitabine-related GI injury shows a GVHD-like pattern. Knowledge of this is important to confirm the diagnosis as patients typically improve with dose reduction or discontinuation of the drug.

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Role of colonoscopy in diagnosis of capecitabine associated ileitis: Two case reports

Cited by 8 publications

References 8 publications

Severe ileum bleeding following adjuvant capecitabine chemotherapy for locally advanced colon cancer: a case report and review of the literature

Severe ileum bleeding following adjuvant capecitabine chemotherapy for locally advanced colon cancer: a case report and review of the literature

Clostridium difficile Infection During Palliative Capecitabine Chemotherapy: A Case Report

Capecitabine-induced Gastrointestinal Injury Shows a Graft-Versus-Host Disease (GVHD)-like Pattern

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