Published online May 16, 2019. doi: 10.4253/wjge.v11.i5.383
Peer-review started: January 29, 2019
First decision: April 13, 2019
Revised: May 9, 2019
Accepted: May 13, 2019
Article in press: May 14, 2019
Published online: May 16, 2019
Processing time: 107 Days and 15 Hours
Capecitabine is considered a first line agent in adjuvant therapy for breast and colorectal cancer. However, cases of severe diarrhea have been reported with increasing frequency in recent years. When diarrhea is severe and prolonged, capecitabine associated ileitis should be considered as a possible etiology.
Herein, we present two cases of capecitabine ileitis, specifically involving the terminal ileum and ascending colon. We will demonstrate the disease course and treatment modalities applied to alleviate this condition, as well as discuss the merits of using colonoscopy to aid in diagnosis.
Ultimately our cases demonstrate that symptomatic management with traditional anti-diarrheal medications is largely ineffective. Prompt recognition and discontinuation of capecitabine is an imperative step in proper management of this condition and colonoscopy with biopsy can be helpful when the diagnosis is unclear.
Core tip: There have been nine published cases describing capecitabine associated ileitis, and only four of these cases document use of colonoscopy. We are presenting the fifth and sixth case reports of colonoscopy-assisted diagnosis of this condition. Combining analysis of these six colonoscopy reports, we determined patterns in the presentation of this condition. Given that the differential etiologies of diarrhea are so broad, we believe that our findings collectively can improve the diagnostic accuracy and optimize treatment. Additionally, we believe that colonoscopy with biopsy should be indicated as a standardized diagnostic measure in patients on capecitabine with refractory diarrhea.