Gastro-Intestinal
Therapy for GI Injury
Many late GI effects are related to chronic Inflammation and fibrosis:
Gastritis and esophagitis:
- Treated with proton pump inhibitor and H2 antagonists
- Carafate - (binds proteins of denuded mucosa) may be helpful
Esophageal stricture from previous RT:
- Barium swallow and endoscopy can identify site of stricture
- May need repeated dilations (every 6 months to a year)
Bowel motility problems:
- Constipation and irritable bowel syndrome can be treated with laxatives - for example: polyethylene glycol
Chronic enteritis:
- Malabsorption from chronic enteritis needs extensive GI investigation to establish the site of the problem (including endoscopy and biopsies).
- Statis syndrome can be treated with antibiotics such as metronidazole
- Refractory malabsorption with villous atrophy is difficult to manage and may require enteral or parenteral nutritional support
Bowel Obstruction:
- Managed conservatively at first with NG suction, IV fluids and bowel rest
- Eventually may require laparatomy and lysis of adhesions
Therapy of Acute Graft versus Host:
- Supportive Care
- Prednisone at 2 mg/ kg which may be combined with cyclosporine
- The addition of anti-thymocyte globulin may be of value
- Refractory cases may be helped by monoclonal antibodies to cytokines and cytokine receptors
Chronic Graft versus Host:
- Treated with Cyclosporine and systemic steroids and topical corticosteroids
- Tacrolimus and mycophenolate mofetil may also be of value
