Dao AE, Hsu A, Nakshabandi A, Mandaliya R, Nadella S, Sivaraman A, Mattar M, Charabaty A. Role of colonoscopy in diagnosis of capecitabine associated ileitis: Two case reports. World J Gastrointest Endosc 2019; 11(5): 383-388 [PMID: 31205599 DOI: 10.4253/wjge.v11.i5.383]
Corresponding Author of This Article
Aline Charabaty, MD, Attending Doctor, Department of Gastroenterology, Johns Hopkins University at Sibley Memorial Hospital, 5255 Loughboro Rd NW, Washington, DC 20016, United States. acharab1@jhmi.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. May 16, 2019; 11(5): 383-388 Published online May 16, 2019. doi: 10.4253/wjge.v11.i5.383
Role of colonoscopy in diagnosis of capecitabine associated ileitis: Two case reports
Alexander E Dao, Angela Hsu, Ahmad Nakshabandi, Rohan Mandaliya, Sandeep Nadella, Anita Sivaraman, Mark Mattar, Aline Charabaty
Alexander E Dao, Angela Hsu, Ahmad Nakshabandi, Rohan Mandaliya, Sandeep Nadella, Anita Sivaraman, Mark Mattar, Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
Aline Charabaty, Department of Gastroenterology, Johns Hopkins University at Sibley Memorial Hospital, Washington, DC 20016, United States
Author contributions: Dao AE contributed to study design, data collection, manuscript writing and editing; Hsu A contributed to data collection, manuscript writing and editing; Nakshabandi A contributed to data collection and manuscript writing; Mandaliya R, Nadella S, Sivaraman A and Mattar M contributed to data collection and editing; Charabaty A contributed to study design, data collection and editing.
Informed consent statement: All procedures performed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute of consent was obtained from all patients prior to inclusion in the study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Aline Charabaty, MD, Attending Doctor, Department of Gastroenterology, Johns Hopkins University at Sibley Memorial Hospital, 5255 Loughboro Rd NW, Washington, DC 20016, United States. acharab1@jhmi.edu
Telephone: +1-202-6605555 Fax: +1-202-6606103
Received: January 29, 2019 Peer-review started: January 29, 2019 First decision: April 13, 2019 Revised: May 9, 2019 Accepted: May 13, 2019 Article in press: May 14, 2019 Published online: May 16, 2019 Processing time: 107 Days and 15 Hours
Abstract
BACKGROUND
Capecitabine is considered a first line agent in adjuvant therapy for breast and colorectal cancer. However, cases of severe diarrhea have been reported with increasing frequency in recent years. When diarrhea is severe and prolonged, capecitabine associated ileitis should be considered as a possible etiology.
CASE SUMMARY
Herein, we present two cases of capecitabine ileitis, specifically involving the terminal ileum and ascending colon. We will demonstrate the disease course and treatment modalities applied to alleviate this condition, as well as discuss the merits of using colonoscopy to aid in diagnosis.
CONCLUSION
Ultimately our cases demonstrate that symptomatic management with traditional anti-diarrheal medications is largely ineffective. Prompt recognition and discontinuation of capecitabine is an imperative step in proper management of this condition and colonoscopy with biopsy can be helpful when the diagnosis is unclear.
Core tip: There have been nine published cases describing capecitabine associated ileitis, and only four of these cases document use of colonoscopy. We are presenting the fifth and sixth case reports of colonoscopy-assisted diagnosis of this condition. Combining analysis of these six colonoscopy reports, we determined patterns in the presentation of this condition. Given that the differential etiologies of diarrhea are so broad, we believe that our findings collectively can improve the diagnostic accuracy and optimize treatment. Additionally, we believe that colonoscopy with biopsy should be indicated as a standardized diagnostic measure in patients on capecitabine with refractory diarrhea.
