title: Radiation-induced hemorrhagic duodenitis associated with sorafenib treatment.
abstract: Sorafenib, an oral inhibitor of multiple tyrosine kinase receptors, has been widely used as a standard medical treatment for advanced hepatocellular carcinoma (HCC). Here, we report a 66-year-old male patient who developed gastrointestinal bleeding due to radiation-induced hemorrhagic duodenitis associated with sorafenib treatment. We started oral administration of sorafenib because of the recurrence of HCC with lung metastases. The patient had been treated by radiotherapy for para-aortic lymph node metastases from HCC 4 months before the bleeding. Esophagogastroduodenoscopy (EGD) revealed edematous reddish mucosa with friability and telangiectasia in the second portion of the duodenum. Computed tomography and capsule endoscopy revealed that the hemorrhagic lesions were located in the distal duodenum. After discontinuation of sorafenib, the bleeding disappeared and a follow-up EGD confirmed improvement of duodenitis. Based on these findings, the diagnosis of radiation-induced hemorrhagic duodenitis associated with sorafenib was made.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Uchimaru 19-1, Morioka, 020-8505, Japan, syanai@iwate-med.ac.jp.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Yanai
authors.forename: Shotaro
authors.initials: S
authors.lastname: Nakamura
authors.forename: Aritsune
authors.initials: A
authors.lastname: Ooho
authors.forename: Shigeo
authors.initials: S
authors.lastname: Nakamura
authors.forename: Motohiro
authors.initials: M
authors.lastname: Esaki
authors.forename: Koichi
authors.initials: K
authors.lastname: Azuma
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000532:radiotherapy; D004382:Duodenitis / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives*; D010671:Phenylurea Compounds / Q000009:adverse effects*; D011832:Radiation Injuries / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects; D020794:Receptor Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib; D020794:Receptor Protein-Tyrosine Kinases
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