Immune checkpoint inhibitor therapy for malignancies may cause mild to severe GI side effects in 8–27% of patients.
Patients with severe diarrhea or dysentery and a known history of IBD or prior immune checkpoint inhibitor therapy require expedited evaluation with stool studies and possible sigmoidoscopy or colonoscopy with biopsy to exclude infection prior to therapy with intravenous corticosteroids.
Shiga-toxin–producing Escherichia coli infection should not be treated with antibiotics due to an increased risk of hemolytic-uremic syndrome, especially in children.
Dougan M et al. Gastroenterology. [PMID: 33080231]
Siciliano V et al. Rev Recent Clin Trials. [PMID: 32598272]
Elevated fasting levels (> 48 ng/mL) of the bile acid precursor 7aC4 are strongly predictive of bile acid diarrhea.
Borup C et al. Am J Gastroenterol. [PMID: 32740083]
Minimally invasive intraluminal approaches that use flexible endoscopes or rigid esophagoscopes are preferred.
Jirapinyo P et al. Gastrointest Endosc. [PMID: 33926711]
OTHER PRIMARY ESOPHAGEAL MOTILITY DISORDERS
Opioids may exacerbate esophageal dysmotility and should be discontinued, if possible. No medications have been shown to improve symptoms in patient with esophageal hypomotility.
DeLay K et al. Clin Gastroenterol Hepatol. [PMID: 34405804]
Commercial laboratories now offer culture-based and molecular-based susceptibility testing for Helicobacter pylori, which may be helpful for patients who have failed an initial empiric course of treatment.
Graham DY. Gastroenterology. [PMID: 33647279]
Endoscopic application of a topical hemostatic powder (Hemospray) may provide temporary hemostasis for up to 24 hours in patients with massive bleeding that interferes with effective application of thermocoagulation or endoclip placement.
Hussein M et al. Endoscopy. [PMID: 32459010]
IRRITABLE BOWEL SYNDROME (IBS)
Peppermint oil may be useful to relieve global IBS symptoms and abdominal pain.
Probiotics are not recommended for IBS treatment.
Lacy BE et al. Am J Gastroenterol. [PMID: 33315591]
INFLAMMATORY BOWEL DISEASE
Ozanimod was FDA-approved for the treatment of moderate to severe ulcerative colitis.
Sandborn WJ et al. N Engl J Med. [PMID: 34587385]
Nucleic acid amplification testing for gonorrhea and chlamydia has excellent sensitivity and specificity and is preferred in most clinical settings.
Workowski KA et al. MMWR Recomm Rep. [PMID: 34292926]