title: Chronic diarrhoea after radiotherapy for gynaecological cancer: occurrence and aetiology.
abstract: The occurrence of chronic diarrhoea was evaluated in 173 consecutive patients previously treated with radiation for gynaecological cancer. A survey of gastrointestinal symptoms showed a high frequency of diarrhoea; 13% of the patients had 21 or more bowel movements a week and 3% had 28 or more. Significantly more patients who had a cholecystectomy were in the group with diarrhoea (chi 2 = 6.26; p less than 0.02). Twenty patients with chronic or intermittent diarrhoea were subject to extended gastrointestinal investigation. Bile acid malabsorption was evaluated by the 75Selenahomocholic acid-taurine test (SeHCAT). Bile acid malabsorption was found in 13 (65%) of the 20 patients further investigated, of whom seven had extremely low whole body retention values, which is consistent with severe malabsorption. The results suggest that bile acid malabsorption is a common cause of diarrhoea after radiation treatment for gynaecological cancer. Bacterial contamination was diagnosed in nine patients (45%) by the [14C]-D-xylose breath test or by the cholyl-[14C]-glycine breath test in combination with a normal test for bile acid malabsorption. All patients with vitamin B-12 deficiency, who were tested for bile acid malabsorption, had low retention times for the SeHCAT (p = 0.05). A significant decline in the frequency of diarrhoea was found after treatment with antibiotics or bile acid sequestrants, or both, in combination with a reduced fat diet.
authors.affiliation: Department of Medicine, University Hospital, Umeå, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Danielsson
authors.forename: H
authors.initials: H
authors.lastname: Nyhlin
authors.forename: H
authors.initials: H
authors.lastname: Persson
authors.forename: U
authors.initials: U
authors.lastname: Stendahl
authors.forename: R
authors.initials: R
authors.lastname: Stenling
authors.forename: O
authors.initials: O
authors.lastname: Suhr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications; D001647:Bile Acids and Salts / Q000378:metabolism; D002908:Chronic Disease; D003967:Diarrhea / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D007408:Intestinal Absorption / Q000528:radiation effects; D008875:Middle Aged; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects
chemical_list: D001647:Bile Acids and Salts