High-potency sucralfate prevents and rapidly reverses chemo-radiation mucositis in a patient with stage 4b head and neck cancer

Table 2 European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group and the World Health Organization toxicity criteria acute chemoradiation morbidity

	Scale for gastrointestinal toxicity
	Grade 0	Grade 1	Grade 2	Grade 3	Grade 4
Esophagus toxicity grade	None	Mild fibrosis; Slight difficulty in swallowing solids; No pain on swallowing	Unable to take solid food normally; Swallowing semi-solid food; Dilation may be indicated	Severe fibrosis; Able to swallow only liquids; May have pain on swallowing; Dilation required	Necrosis/Perforation Fistula
Small bowel toxicity grade	None	Mild diarrhea; Mild cramping; Bowel movement 5 times daily	Moderate diarrhea and colic; Bowel movement > 5 times daily	Obstruction or bleeding, requiring surgery	Necrosis/Perforation Fistula
Colorectal toxicity grade	None	Increased frequency or change in quality of bowel habits not requiring medication, rectal discomfort not requiring analgesics; Slight rectal discharge or bleeding	Diarrhea requiring parasympatholytic drugs, mucous discharge not necessitating sanitary pads, rectal or abdominal pain requiring analgesics; Excessive rectal mucus or intermittent bleeding	Diarrhea requiring parenteral support, severe mucous or bloody discharge necessitating sanitary pads/abdominal distension (flat plate radiograph demonstrates distended bowel loops)	Acute or subacute obstruction, fistula or perforation; gastrointestinal bleeding requiring transfusion; abdominal pain or tenesmus requiring tube decompression or bowel diversion
World Health Organization colorectal	None	Increase of 2-3 stools per day over pretreatment	Increase of 4-6 stools per day, or nocturnal stools, or moderate cramping	Increase of 7-9 stools per day, or incontinence, or severe cramping	Increase of > 10 stools per day or grossly bloody diarrhea, or need for parenteral support
Toxicity grade