Chemotherapy-induced lactose intolerance in adults

Parnes, Howard L.; Fung, Ron; Schiffer, Charles A.

doi:10.1002/1097-0142(19940901)74:5<1629::aid-cncr2820740523>3.0.co;2-l

Cited by 27 publications

(12 citation statements)

References 17 publications

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“…New-onset lactose intolerance is the cause of diarrhoea and bloating during 5-fluorouracil chemotherapy in 10% of patients 14 15. Clinical experience suggests that small bowel bacterial overgrowth, bile acid malabsorption and pancreatic insufficiency are three other important contributory factors to chemotherapy-induced GI symptoms 16…”

Section: Pathophysiology Of Side Effects Of Cancer Therapiesmentioning

confidence: 99%

Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer

Andreyev

Davidson

Gillespie

et al. 2011

Gut

248

194

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BackgoundThe number of patients with chronic gastrointestinal (GI) symptoms after cancer therapies which have a moderate or severe impact on quality of life is similar to the number diagnosed with inflammatory bowel disease annually. However, in contrast to patients with inflammatory bowel disease, most of these patients are not referred for gastroenterological assessment. Clinicians who do see these patients are often unaware of the benefits of targeted investigation (which differ from those required to exclude recurrent cancer), the range of available treatments and how the pathological processes underlying side effects of cancer treatment differ from those in benign GI disorders. This paper aims to help clinicians become aware of the problem and suggests ways in which the panoply of syndromes can be managed.MethodsA multidisciplinary literature review was performed to develop guidance to facilitate clinical management of GI side effects of cancer treatments.ResultsDifferent pathological processes within the GI tract may produce identical symptoms. Optimal management requires appropriate investigations and coordinated multidisciplinary working. Lactose intolerance, small bowel bacterial overgrowth and bile acid malabsorption frequently develop during or after chemotherapy. Toxin-negative Clostridium difficile and cytomegalovirus infection may be fulminant in immunosuppressed patients and require rapid diagnosis and treatment. Hepatic side effects include reactivation of viral hepatitis, sinusoidal obstruction syndrome, steatosis and steatohepatitis. Anticancer biological agents have multiple interactions with conventional drugs. Colonoscopy is contraindicated in neutropenic enterocolitis but endoscopy may be life-saving in other patients with GI bleeding. After cancer treatment, simple questions can identify patients who need referral for specialist management of GI symptoms. Other troublesome pelvic problems (eg, urinary, sexual, nutritional) are frequent and may also require specialist input. The largest group of patients affected by chronic GI symptoms are those who have been treated with pelvic radiotherapy. Their complex symptoms, often caused by more than one diagnosis, need systematic investigation by gastroenterologists when empirical treatments fail. All endoscopic and surgical interventions after radiotherapy are potentially hazardous as radiotherapy may induce significant local ischaemia. The best current evidence for effective treatment of radiation-induced GI bleeding is with sucralfate enemas and hyperbaric oxygen therapy.ConclusionsAll cancer units must develop simple methods to identify the many patients who need help and establish routine referral pathways to specialist gastroenterologists where patients can receive safe and effective treatment. Early contact with oncologists and/or specialist surgeons with input from the patient's family and friends often helps the gastroenterologist to refine management strategies. Increased training in the late effects of cancer treatment is required.

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Section: Pathophysiology Of Side Effects Of Cancer Therapiesmentioning

confidence: 99%

Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer

Andreyev

Davidson

Gillespie

et al. 2011

Gut

248

194

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“…When the epithelium heals, the activity of lactase returns. However, secondary maldigestion does not automatically lead to severe symptoms of intolerance [13,14].…”

Section: Hypolactasia Lactose Maldigestion and Lactose Intolerancementioning

confidence: 99%

Lactose Intolerance

Vesa¹,

Marteau

Korpela³

2000

Journal of the American College of Nutrition

293

164

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Lactose maldigestion has been under intensive research since its discovery in the 1960's. We know the prevalence of lactose maldigestion in a great number of countries and ethnic groups. However, there is often no provision made for the secondary type of maldigestion, and the study populations have sometimes been selected rather than picked at random. New methods for the measurement of lactose digestion have been developed, and its genetic mechanisms have received a great deal of attention during the last few years. However, in many studies the measurement and/or reporting of symptoms has quite often been overlooked. In this review, various topics related to lactose intolerance are discussed with a special emphasis on its symptoms.

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“…Thus, a negative HBT may be due to a shift from hydrogen to methanogen-producing bacteria. The lactose-HBT has been previously applied in patients, both children 50 and adults, 51 with varying results, but overall it non-Caucasians exhibit an age-related low lactase activity, 46 indicating that the 13 C-lactose breath test is not a suitable marker of small intestinal damage. In comparison, sucrase levels in the brushborder remain relatively constant throughout life, 65 and only 0.2% of the population present with a genetic sucrase deficiency.…”

Section: Methods For Assessing Small Intestinal Functionmentioning

confidence: 99%

Mucositis and non-invasive markers of small intestinal function

Tooley

Howarth²,

Butler³

2009

Cancer Biology & Therapy

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Mucositis is a common and debilitating side effect of chemotherapy that manifests due to the inability of chemotherapy agents to discriminate between normal and neoplastic cells. This results in ulcerating lesions lining the gastrointestinal tract. Moreover, the development of efficacious treatments for small intestinal mucositis has been hindered as the pathobiology of mucositis is still not fully understood. The small intestine is an extensive organ which is largely inaccessible by conventional means. Non-invasive biomarkers such as small intestinal permeability, H 2 breath tests, serum citrulline tests and the 13 C-sucrose breath test (SBT) have emerged as potential markers of small intestinal function. The SBT is emerging as the more appropriate biomarker to assess chemotherapy-induced mucositis in cancer patients and animal models, where it measures the decrease in sucrase activity associated with villus blunting and crypt disruption. The SBT has been successfully applied to detect mucositis induced by different classes of chemotherapy agents and has been used successfully to monitor small intestinal function with a range of candidate anti-mucositis treatments. We propose the SBT a superior biomarker of small intestinal function that could be successfully applied in clinical practice for monitoring the development of mucositis in cancer patients undergoing chemotherapy.

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Chemotherapy-induced lactose intolerance in adults

Cited by 27 publications

References 17 publications

Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer

Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer

Lactose Intolerance

Mucositis and non-invasive markers of small intestinal function

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