Risk of thiamine deficiency and Wernicke's encephalopathy after gastrointestinal surgery for cancer.
BACKGROUND
Cancer patients submitted to gastrointestinal surgery are at risk of thiamine deficiency (TD) and Wernicke's encephalopathy (WE). Although permanent neurological damage and death could be prevented by a timely replacement therapy, they often remain undiagnosed and untreated. We hypothesized that WE remains unrecognized because most cases may manifest several months after hospital discharge.


METHODS
WE frequency was investigated in a sample of cancer patients who underwent gastrointestinal surgery, by using the diagnostic criteria proposed to improve diagnosis among alcoholics. Patients were evaluated at discharge through the examination of medical records and 6 months after by telephonic interview.


RESULTS
Forty-five patients were selected. Signs of WE resulted in 4.4% at discharge. At 6 months, 21 patients were interviewed. Among them, 90.4% had signs of WE. The number of affected patients was significantly higher 6 months after discharge than at discharge (90.4 vs 9.5%, p < 0.0001).


CONCLUSIONS
Further studies with larger samples are needed to establish the prevalence of TD and related WE in cancer patients after gastrointestinal surgery. This study suggests that the problem is understated. Even in absence of symptoms of TD, the use of prophylactic thiamine supplementation should be taken in consideration, as consequences of misdiagnosis can be severe.
Department of Surgery, Colorectal Surgery Center, University of Cagliari, Policlinico Universitario, 09100, Cagliari, Italy. arestivo@unica.it.
Angelo
A
Restivo
Unit of Psychosomatics and Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.
Mauro Giovanni
MG
Carta
Clinical Nutrition Center, Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy.
Anna Maria Giulia
AMG
Farci
Clinical Nutrition Center, Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy.
Laura
L
Saiu
Neuroscience Institute, National Research Council of Italy, Section of Cagliari, Cagliari, Italy.|Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.
Gian Luigi
GL
Gessa
Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.
Roberta
R
Agabio
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D019587:Dietary Supplements; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D013831:Thiamine / Q000097:blood / Q000627:therapeutic use*; D014899:Wernicke Encephalopathy / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D055815:Young Adult
D013831:Thiamine
Colorectal cancer; Gastrointestinal cancer; Thiamine deficiency therapy; Wernicke’s encephalopathy prevention