The GI Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Sutton, UK.
Curr Opin Support Palliat Care. 2010 Mar;4(1):19-25. doi: 10.1097/SPC.0b013e32833575cc.
Gastrointestinal toxicity during chemotherapy is frequent. Symptomatic therapies for gastrointestinal toxicity, which do not address the underlying cause, may result in inadequate symptom control. With advances in curative treatment regimens, it becomes more important to minimize treatment toxicity which otherwise may compromise optimal chemotherapy and the chance of cure.
For decades, oncologists have concentrated on delineating the pathological processes, which occur within the gastrointestinal tract during chemotherapy treatment. However, pathological change does not in itself cause symptoms. Symptoms only arise when physiological functions are altered. In immunosuppressed patients, it is a priority to exclude infection as a cause for symptoms. In the presence of diarrhoea, the best investigative paradigm for this is stool culture, upper gastrointestinal endoscopy with duodenal biopsies and duodenal aspirate combined with flexible sigmoidoscopy and left colonic biopsies. Once infection has been excluded, although large studies have not been performed, case series repeatedly suggest that gastrointestinal symptoms arising during cancer chemotherapy can often be cured if newly acquired, gastrointestinal physiological deficits are identified.
Although many physiological changes induced by chemotherapy may be relatively transient and settle weeks or months after the end of treatment, during chemotherapy, their manifestations can be protean and severe. A systematic failure to research the frequency with which physiological causes of the symptoms are amenable to treatment has denied many patients' logical therapies for their chemotherapy-induced symptoms, and as a result, it is likely that symptomatic treatments are frequently suboptimal.
化疗期间常发生胃肠道毒性。对症治疗胃肠道毒性但不针对根本病因的方法可能导致症状控制不足。随着治愈性治疗方案的进展，最大限度地减少治疗毒性变得更为重要，否则可能会影响最佳化疗和治愈机会。
几十年来，肿瘤学家一直致力于描绘化疗期间胃肠道内发生的病理过程。然而，病理变化本身并不会引起症状。只有当生理功能发生改变时才会出现症状。在免疫抑制患者中，当务之急是排除感染是症状的原因。腹泻时，最佳的研究范式是粪便培养、上消化道内镜检查伴十二指肠活检和十二指肠抽吸，结合柔性乙状结肠镜检查和左结肠活检。一旦排除了感染，尽管尚未进行大型研究，但病例系列反复表明，如果发现新出现的胃肠道生理缺陷，癌症化疗期间出现的胃肠道症状通常可以治愈。
尽管许多由化疗引起的生理变化可能相对短暂，并在治疗结束数周或数月后消失，但在化疗期间，其表现可能多种多样且严重。系统地未能研究症状的生理原因可治疗的频率，使许多患者被剥夺了针对其化疗引起的症状的合理治疗，因此，对症治疗很可能经常不尽如人意。
