Gadhok Radha, Paulon Emma, Tai Chehkuan, Olushola Tomisin, Barragry John, Rahman Farooq, Di Caro Simona, Mehta Shameer
Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK.
Frontline Gastroenterol. 2020 Aug 11;12(6):471-477. doi: 10.1136/flgastro-2020-101430. eCollection 2021.
Up to 90% of patients treated for pelvic cancers experience chronic gastrointestinal (GI) symptoms. This study characterises this patient cohort at a single centre, addressing a paucity of publications reporting 'real-world' experiences.
Outpatient referrals, from oncology to the gastroenterology and nutrition services, at a tertiary London hospital from 2006 to 2016, were retrospectively identified. Patient characteristics, reported symptoms, investigations, diagnoses, response to therapeutics and follow-up were recorded.
Of 269 patients referred, 81% were within the latter 5 years. A total of 260 patients had diagnoses of pelvic cancers (prostatic (52%), cervical (19%) and endometrial (19%)). Among 247 treated with radiotherapy, the median time from radiotherapy to symptom onset was 8 months. Common symptoms were rectal bleeding (51%), diarrhoea (32%), faecal urgency (19%) and pain (19%). Patients underwent a median of three investigations including lower GI endoscopy (86%), thyroid function tests (33%) and glucose hydrogen breath test (30%). Diagnoses included radiation proctopathy (39%), colonic polyps (16%), pelvic floor dysfunction (12%), bile acid malabsorption (BAM) (8%), small intestinal bacterial overgrowth (SIBO) (8%), vitamin D deficiency (7%) and iron deficiency (7%). Among 164 discharged patients, the time to discharge was 7 months, after a median of two appointments.
This unique patient group reports a complex mix of symptoms and requires specialist review and consideration of often uninvestigated diagnoses (pelvic dysfunction, BAM, SIBO and nutritional deficiencies). Such patients are often overlooked, compared with those suffering many other chronic GI disorders. Further reports from non-dedicated centres treating patients with pelvic radiation disease will aid in understanding of secondary GI diagnoses and variation in practice.
接受盆腔癌治疗的患者中，高达90%会出现慢性胃肠道（GI）症状。本研究对单一中心的这一患者群体进行了特征描述，以填补报告“真实世界”经验的出版物的不足。
回顾性确定2006年至2016年伦敦一家三级医院从肿瘤学转诊至胃肠病学和营养服务部门的门诊患者。记录患者特征、报告的症状、检查、诊断、治疗反应和随访情况。
在转诊的269名患者中，81%是在最近5年内转诊的。共有260名患者被诊断为盆腔癌（前列腺癌（52%）、宫颈癌（19%）和子宫内膜癌（19%））。在接受放疗的247名患者中，从放疗到症状出现的中位时间为8个月。常见症状包括直肠出血（51%）、腹泻（32%）、排便急迫感（19%）和疼痛（19%）。患者平均接受了三项检查，包括下消化道内镜检查（86%）、甲状腺功能测试（33%）和葡萄糖氢呼气试验（30%）。诊断包括放射性直肠炎（39%）、结肠息肉（16%）、盆底功能障碍（12%）、胆汁酸吸收不良（BAM）（8%）、小肠细菌过度生长（SIBO）（8%）、维生素D缺乏（7%）和缺铁（7%）。在164名出院患者中，出院时间为7个月，平均就诊两次。
这个独特的患者群体报告了一系列复杂的症状，需要专家进行评估，并考虑通常未被调查的诊断（盆腔功能障碍、BAM、SIBO和营养缺乏）。与患有许多其他慢性胃肠道疾病的患者相比，这类患者常常被忽视。来自治疗盆腔放射病患者的非专门中心的进一步报告将有助于了解继发性胃肠道诊断和实践差异。
