Muls Ann C, Watson Lorraine, Shaw Clare, Andreyev H Jervoise N
The GI unit, Department of Medicine, The Royal Marsden Hospital, London and Sutton, UK.
The Department of Nutrition and Dietetics, The Royal Marsden Hospital, London and Sutton, UK.
Frontline Gastroenterol. 2013 Jan;4(1):57-68. doi: 10.1136/flgastro-2012-100218. Epub 2012 Oct 2.
The percentage of the population living with a diagnosis of cancer is rising. By 2030, there will be 4 million cancer survivors in the UK. One quarter of cancer survivors are left with physical symptoms, which affect their quality of life. Gastrointestinal (GI) symptoms are the most common of all chronic physical side-effects of cancer treatment and have the greatest impact on daily activity. Cancer therapies induce long-term changes in bowel function due to alterations to specific GI physiological functions. In addition, the psychological effect of a cancer diagnosis, new GI disease or pre-existing underlying conditions, may also contribute to new symptoms. Twenty-three upper GI symptoms have been identified as occurring after pelvic radiotherapy. After upper GI cancer treatment, the most troublesome symptoms include reflux, abdominal pain, indigestion, diarrhoea and fatigue. Often, several symptoms are present simultaneously and women experience more symptoms than men. The symptoms which patients rate as most difficult are urgency, wind, diarrhoea, incontinence, abdominal pain and rectal bleeding. Recent UK Guidance on managing GI symptoms suggests that these symptoms can be treated especially if gastroenterological advice is combined with dietetic and nursing input to optimise investigations and management. However, as different pathological processes can result in identical symptoms; a systematic, 'algorithmic' approach to assess and treat these symptoms is required. This paper aims to illustrate the value of such an approach to investigate and treat the most common GI symptoms that trouble patients. The algorithm allows clinicians to institute a comprehensive medical management plan.
被诊断患有癌症的人口比例正在上升。到2030年，英国将有400万癌症幸存者。四分之一的癌症幸存者会出现身体症状，这会影响他们的生活质量。胃肠道（GI）症状是癌症治疗所有慢性身体副作用中最常见的，对日常活动影响最大。癌症治疗会因特定胃肠道生理功能的改变而导致肠道功能发生长期变化。此外，癌症诊断、新的胃肠道疾病或先前存在的潜在疾病所带来的心理影响，也可能导致新的症状出现。已确定有23种上消化道症状会在盆腔放疗后出现。在上消化道癌症治疗后，最麻烦的症状包括反流、腹痛、消化不良、腹泻和疲劳。通常，几种症状会同时出现，而且女性比男性出现的症状更多。患者认为最难忍受的症状是尿急、肠胃胀气、腹泻、失禁、腹痛和直肠出血。英国最近关于管理胃肠道症状的指南表明，这些症状是可以治疗的，特别是如果将胃肠病学建议与饮食和护理方面的投入相结合，以优化检查和管理。然而，由于不同的病理过程可能导致相同的症状，因此需要一种系统的“算法”方法来评估和治疗这些症状。本文旨在说明这种方法在调查和治疗困扰患者的最常见胃肠道症状方面的价值。该算法使临床医生能够制定全面的医疗管理计划。
