Chronic diarrhoea after radiotherapy for gynaecological cancer: occurrence and aetiology

Article Abstract:

During or immediately following radiation therapy for gynecological cancer, severe diarrhea has been reported to occur in up to 15 percent of patients. This early-onset diarrhea is quite different from the less well described chronic diarrhea that usually does not begin for at least one year after radiotherapy and may continue for the remainder of the patient's life. In the late-onset postradiation therapy diarrhea, malabsorption of fat and bile acids as well as alterations in gastrointestinal motility and pseudo-obstruction of the intestine may be present. To evaluate factors responsible for the onset of chronic diarrhea in patients following radiotherapy, a study was carried out involving 173 consecutive patients treated 3 to 32 years (average 9 years) previously with radiation therapy for gynecological cancer. Thirteen percent of the patients reported diarrhea (21 or more bowel movements per week); 3 percent reported severe diarrhea (28 or more bowel movements per week). Significantly more patients who had undergone cholecystectomy (removal of the gall bladder) suffered from postradiotherapy diarrhea. Twenty patients suffering from diarrhea were subjected to a more in-depth evaluation. Sixty-five percent of this group were found to have impaired bile acid absorption; 45 percent were found to have bacterial contamination. A treatment regimen consisting of antibacterial therapy or bile salt sequestrants and a reduced fat diet was imposed, resulting in a significant decline in the frequency of diarrhea. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer, Cancer treatment, Radiotherapy

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Investigation of seemingly pathogen-negative diarrhoea in patients infected with HIV1

Article Abstract:

Patients suffering from AIDS are frequently (about 50 percent of the time) afflicted with diarrhea. In some patients, no evidence is found of a bacterial or viral (other than the HIV) infection which could account for the diarrhea. The more tests performed, the greater the likelihood of discovering a pathogen (disease-causing microorganism), but some cases are particularly difficult to diagnose. It is thought that infection of the lining of the gastrointestinal tract by the AIDS virus itself may result in malabsorption and diarrhea. In order to characterize AIDS patients suffering from diarrhea who did not have any gastrointestinal infection on initial examination, a study was done of 33 AIDS patients. All the patients complained of diarrhea, but could not be diagnosed after examination of six stool samples and microscopic analysis of rectal tissue. Numerous additional diagnostic tests were performed. In 12 of the patients, diagnosis of bacterial or viral infection was eventually made. In the 9 patients with less than 10 pounds of weight loss or stool volume less than 400 milliliters per day, no pathogens were discovered. Of the 13 patients with weight loss greater than 22 pounds and stool volumes greater than 800 milliliters per day, pathogens were identified in nine (69 percent). A simple scoring system is presented based on weight loss and intestinal absorption tests that may help to identify AIDS patients who are most likely to benefit from further diagnostic tests. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, HIV patients

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Histological diagnosis of intestinal microsporidosis in patients with AIDS

Article Abstract:

The human immunodeficiency virus (HIV), the virus that causes AIDS, attacks and destroys the immune system. This means that people with AIDS have a greater risk of developing infections. Microsporidia are microorganisms that cause diarrhea in 30 percent of patients with HIV infection. This microorganism has been found in the intestines of patients with AIDS, and is becoming more common in AIDS patients in Europe, North America, and Africa. There are currently no blood tests available for diagnosing microsporidia infections. Examination of tissue samples with the electron microscope, an expensive technique, is currently the recommended method of detection. In this study, the light microscope was used to determine the prevalence of microsporidial infections in 79 patients with HIV infection. Of these patients, 59 had diarrhea, and 20 had weight loss and no diarrhea. Tissue samples were taken from the intestines (duodenum and jejunum) of all patients. Based on the tissue samples, eight of the patients with diarrhea were diagnosed with microsporidial infection. No microsporidial infection was found in the patients without diarrhea. It is concluded that examination of intestine biopsy samples with the light microscope is useful in diagnosing microsporidial infections in patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Identification and classification, Intestines, Biopsy, Microsporidia, Microsporida

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