Background: Irinotecan is an established therapeutic option in colorectal cancer. An essential side effect of irinotecan treatment is the induction of severe WHO grade 3–4 delayed diarrhea in up to 25% of treated patients. The aim of the study is the prevention of delayed diarrhea with cholestyramine/levofloxacin. Patients and Methods: Fifty-one patients with a mean age of 64 years (range: 41–81 years) with metastatic colorectal cancer in second-line treatment were included. A cycle corresponds to 4 applications of irinotecan 250 mg/m², every 2 weeks, then a break of 2 weeks. Results: After 1 treatment cycle 12% of patients achieved a partial response, 59% had stable disease and 29% progressive disease. Twenty-two patients received a second or more cycles to a total of 379 applications. Forty patients did not develop diarrhea whereas 11 patients had WHO 1–2 diarrhea after at least 1 application of chemotherapy. Diarrhea WHO 3 occurred in only 1 patient (2%) whereas severe diarrhea WHO 4 did not occur. Conclusion: The combination of cholestyramine/levofloxacin is a promising option for the prevention of delayed diarrhea caused by irinotecan. This prophylactic regime may help in future to escalate the dose of irinotecan as a monotherapy or in combination protocols.

The German S3 guideline "H. pylori and gastroduodenal ulcer disease" clearly recommends how to diagnose H. pylori infection. It also states when and how eradication therapy should be done. However, there are only few data available on the management of these patients in daily routine. With this survey, we wanted to gather information on how primary care physicians are involved in the management of H. pylori infection and how they follow the guideline recommendations. From this, consequences for the update of the new S2k guideline 2016 and their communication should be derived. A questionnaire with 16 items was sent to all registered primary care physicians in the district of Unterfranken, Germany. Of the 607 questionnaires sent out, 188 (31 %) were returned. A test for H. pylori was induced in 76 % of cases with a history of ulcers, 66 % of dyspepsia, 55 % of a family history of gastric cancer, 54 % of unspecific abdominal discomfort, and 9 % and 6 % before initiating NSAID or ASS medication, respectively. Eighty-six percent of the physicians referred their patients to a gastroenterologist for further diagnostics, 45,8 % initiated eradication therapy by themselves, and 75 % and 25 % favored the French and Italian protocol, respectively. The majority did not consider a possible primary resistance to clarithromycine. Twenty-six percent did not regularly control the success of first-line eradication therapy. In case of control, the time intervals after end of eradication treatment are nearly always considered. Second-line therapy is initiated in 99 %, and its success is checked in 87 %. Management of patients with H. pylori infection does not always follow the recommendations of current guidelines. The reasons for that were addressed in the formulation of the updated S2k guideline and will be communicated.

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