Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review

Schiepatti, Annalisa; Premoli, Andrea C.; Maimaris, Stiliano; Rizzo, Mimma; Marples, Maria; Villani, Laura; Scott, Nigel; Sottotetti, Federico; Sanders, David S.; Biagi, Federico; Donnellan, Clare

doi:10.7573/dic.2022-6-3

Cited by 5 publications

(7 citation statements)

References 36 publications

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“… 19 , 20 Interestingly, rare cases of new onset of celiac disease have been described, although its relationship with ICI treatment is not well demonstrated, and it is unclear whether the therapy with ICIs simply acts as a trigger factor that exacerbates an underlying subclinical enteropathy, leading to overt clinical manifestations, or induces celiac disease ex-novo, as it has been previously reported for other immune-related disorders. 21 , 22 In the majority of cases described, the gluten-free diet was sufficient to reverse the damage, and there was no therapeutic interruption. 22 …”

Section: Gastrointestinal Toxicitiesmentioning

confidence: 98%

“… 21 , 22 In the majority of cases described, the gluten-free diet was sufficient to reverse the damage, and there was no therapeutic interruption. 22 …”

Section: Gastrointestinal Toxicitiesmentioning

confidence: 98%

“…Notably, 2 main clinical phenotypes of small bowel involvement related to ICIs have been identified: the first is characterized by enteropathy with villous atrophy (VA), whether or not related to celiac disease, and the second is characterized by generally severe ulcerative enteritis, sometimes with massive gastrointestinal bleeding or perforation of the small intestine but without any mention of VA. 22 , 23 …”

Section: Gastrointestinal Toxicitiesmentioning

confidence: 99%

“…Similar to the case with colonic involvement, the use of steroids, in particular, budesonide administered according to the Mayo Clinic open capsule schedule, and infliximab may be useful in treating the side effects of ICI related to small bowel involvement. 22 , 23 , 25 …”

Section: Gastrointestinal Toxicitiesmentioning

confidence: 99%

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Focus on Immune Checkpoint Inhibitors-related Intestinal Inflammation: From Pathogenesis to Therapeutical Approach

Del Gaudio,

Di Vincenzo,

Petito

et al. 2023

Inflammatory Bowel Diseases

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Recently, antitumor immunotherapies have witnessed a breakthrough with the emergence of immune checkpoint inhibitors (ICIs) including programmed cell death-1 (PD-1), programmed cell death-ligand 1 (PD-L1), and cytotoxic T lymphocyte antigen 4 (CTLA-4) inhibitors. Unfortunately, the use of ICIs has also led to the advent of a novel class of adverse events that differ from those of classic chemotherapeutics and are more reminiscent of autoimmune diseases, the immune-related adverse events (IRAEs). Herein, we performed an insight of the main IRAEs associated with ICIs, focusing on gastroenterological IRAEs and specifically on checkpoint inhibitor colitis, which represents the most widely reported IRAE to date. We comprehensively dissected the current evidence regarding pathogenesis, diagnosis, and management of ICIs-induced colitis, touching upon also on innovative therapies.

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Section: Gastrointestinal Toxicitiesmentioning

confidence: 98%

“… 21 , 22 In the majority of cases described, the gluten-free diet was sufficient to reverse the damage, and there was no therapeutic interruption. 22 …”

Section: Gastrointestinal Toxicitiesmentioning

confidence: 98%

Section: Gastrointestinal Toxicitiesmentioning

confidence: 99%

Section: Gastrointestinal Toxicitiesmentioning

confidence: 99%

See 2 more Smart Citations

Focus on Immune Checkpoint Inhibitors-related Intestinal Inflammation: From Pathogenesis to Therapeutical Approach

Del Gaudio,

Di Vincenzo,

Petito

et al. 2023

Inflammatory Bowel Diseases

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“…In conclusion, enteropathies due to olmesartan and, more rarely, to other ARBs still have an undefined pathogenesis. We believe that the study of intestinal microbiota in drug-related enteropathies with villous atrophy such as those due to ARBs or immune-checkpoint inhibitors 7,8 may represent a target for future studies and a potential candidate for personalised therapies.…”

mentioning

confidence: 99%

Letter: The enigma ofangiotensin receptor blocker‐associated enteropathy—Authors' reply

Schiepatti,

Maimaris,

Biagi

et al. 2024

Aliment Pharmacol Ther

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Immune checkpoint inhibitor-induced diarrhea and colitis: an overview

Zoghbi,

Burk,

Haroun

et al. 2024

Support Care Cancer

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Immune checkpoint inhibitors (ICIs) have emerged as an integral component of the management of various cancers and have contributed to significant improvements in overall survival. Most available ICIs target anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA4), and anti-programmed cell death 1/programmed cell death ligand 1 (anti-PD1/PDL1). Gastrointestinal immune-related adverse events remain a common complication of ICIs. The predominant manifestations include diarrhea and colitis, which often manifest concurrently as immune-mediated diarrhea and colitis (IMDC). Risk factors for developing these side effects include baseline gut microbiota, preexisting autoimmune disorders, such as inflammatory bowel disease, and type of neoplasm. The hallmark symptom of colitis is diarrhea which may be accompanied by mucus or blood in stools. Patients may also experience abdominal pain, fever, vomiting, and nausea. If not treated rapidly, ICI-induced colitis can lead to serious life-threatening complications. Current management is based on corticosteroids as first-line, and immunosuppressants like infliximab or vedolizumab for refractory cases. Microbiota transplantation and specific cytokines and lymphocyte replication inhibitors are being investigated. Optimal patient care requires maintaining a balance between treatment toxicity and efficacy, hence the aim of this review is to enhance readers’ comprehension of the gastrointestinal adverse events associated with ICIs, particularly IMDC. In addition to identifying the risk factors, we discuss the incidence, clinical presentation, workup, and management options of IMDC.

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Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review

Abstract: Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review.

Cited by 5 publications

References 36 publications

Focus on Immune Checkpoint Inhibitors-related Intestinal Inflammation: From Pathogenesis to Therapeutical Approach

Focus on Immune Checkpoint Inhibitors-related Intestinal Inflammation: From Pathogenesis to Therapeutical Approach

Letter: The enigma ofangiotensin receptor blocker‐associated enteropathy—Authors' reply

Immune checkpoint inhibitor-induced diarrhea and colitis: an overview

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