Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

J Bierwirth,M Hentrich,G Maschmeyer,Maria J G T Vehreschild,M Schmidt-Hieber,O A Cornely,D Buchheidt,J J Vehreschild,E Schalk

doi:10.1007/s00277-017-3183-7

Abstract

Cancer patients frequently suffer from gastrointestinal complications. In this manuscript, we update our 2013 guideline on the diagnosis and management of gastrointestinal complications in adult cancer patients by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). An expert group was put together by the AGIHO to update the existing guideline. For each sub-topic, a literature search was performed in PubMed, Medline, and Cochrane databases, and strengths of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using the 2015 European Society for Clinical Microbiology and Infectious Diseases (ESCMID) criteria. Final recommendations were approved by the AGIHO plenary conference. Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. Strengths of recommendation and levels of evidence are presented. A multidisciplinary approach to the diagnosis and management of gastrointestinal complications in cancer patients is mandatory. Evidence-based recommendations are provided in this updated guideline.

Highlights

Abdominal complications are a frequent problem in patients with hematological malignancies or solid tumors
The strength of recommendation and the quality of evidence for major therapeutic strategies were categorized using the current criteria of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID, Table 1) which include an index to the level II recommendations, where appropriate [2]
Therapy-associated diarrhea In cancer patients, factors related to toxic effects of chemotherapy are the most common cause of abdominal complications. 5-fluorouracil, irinotecan, capecitabine, anthracyclines, and a number of small molecules and monoclonal antibodies have been associated with therapyassociated diarrhea [17,18,19,20,21,22,23,24,25]

Summary

Introduction

Abdominal complications are a frequent problem in patients with hematological malignancies or solid tumors. In 2013, we published the first version of “Diagnosis and management of gastrointestinal complications in adult cancer patients: evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)”, one of the first comprehensive, practical, and evidence-based guidelines covering the epidemiology, pathophysiology, diagnosis and treatment of most non-infectious and infectious complications as well as the corresponding hygiene measures [1]. The present update takes the evolving basis of evidence into consideration. The section on infectious complications caused by parasites has been considerably expanded in response to the increasing mobility of our patients. Ann Hematol (2018) 97:31–49 existent recommendations from other guideline panels were incorporated into this overview

Methods

Findings

B III -Use warm water and plain soap for hand hygiene after patient contact