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Colonoscopic evaluation of diarrhea/colitis occurring as an immune-related adverse event.

作为免疫相关不良事件发生的腹泻/结肠炎的结肠镜评估。

  • 影响因子:2.04
  • DOI:10.1093/jjco/hyaa203
  • 作者列表:"Yamauchi Y","Arai M","Akizue N","Ohta Y","Okimoto K","Matsumura T","Fan MM","Imai C","Tawada A","Kato J","Kato N","Takiguchi Y
  • 发表时间:2021-03-03
Abstract

OBJECTIVE:Diarrhea is often observed as an immune-related adverse event. In this study, we conducted a retrospective review of the severity of diarrhea, its treatment and the endoscopic findings in patients developing diarrhea as an immune-related adverse event. METHODS:From August 2015 to June 2019, a total of 369 patients received treatment with immune checkpoint inhibitors at our hospital. For this study, development of grade 2 or more diarrhea in these patients was defined as an immune-related adverse event. We analyzed the histopathological severity of the bowel lesions according to the Nancy histological index for ulcerative colitis. RESULTS:Of the 369 patients, 27 (7.3%) developed diarrhea as an immune-related adverse event. Of these 27 patients, 18 received steroid treatment. Colonoscopy was performed in 17 patients and culture of the feces in 18. The tests revealed evidence of bacterial colitis (Aeromonas hydrophila) in two patients. The Nancy histological index was 4, 3, 2, 1 and 0 in two, three, two, two and seven patients, respectively. No findings on colonoscopy were observed in 7 of the 17 patients (41%) who underwent colonoscopy, and most of these patients recovered without steroid treatment. Patients with lower values of the Nancy histological index tended to show better responses to steroid treatment. CONCLUSIONS:To avoid unnecessary steroid administration, colonoscopic evaluation is essential in patients receiving treatment with immune checkpoint inhibitors who present with diarrhea as an immune-related adverse event. In addition, the endoscopic findings could be useful to predict the response to steroid treatment.

摘要

目的: 腹泻通常被观察为免疫相关的不良事件。在这项研究中,我们对腹泻的严重程度,治疗和内镜检查结果进行了回顾性分析,患者发展为免疫相关的不良事件。 方法: 自2015年8月至2019年6月,共有369例患者在我院接受免疫检查点抑制剂治疗。在本研究中,这些患者发生2级或以上腹泻被定义为免疫相关不良事件。我们根据溃疡性结肠炎的Nancy组织学指数分析了肠道病变的组织病理学严重程度。 结果: 369例患者中,27例 (7.3%) 发生免疫相关不良事件腹泻。这27例患者中,18例接受类固醇治疗。17例患者进行结肠镜检查,18例进行粪便培养。测试显示两名患者有细菌性结肠炎 (嗜水气单胞菌) 的证据。Nancy组织学指数分别为4、3、2和7例患者的4、3、2、1和0。在17例接受结肠镜检查的患者中,7例 (41%) 没有观察到结肠镜检查结果,其中大多数患者在没有类固醇治疗的情况下康复。Nancy组织学指数值较低的患者倾向于对类固醇治疗显示更好的反应。 结论: 为了避免不必要的类固醇给药,在接受免疫检查点抑制剂治疗的患者中,结肠镜检查评估是必不可少的,这些患者以腹泻作为免疫相关不良事件。此外,内窥镜检查结果可能有助于预测对类固醇治疗的反应。

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