小腸結腸炎 (enterocolitis) 是消化道的發炎，以腸道黏膜的發炎為主，臨床表現的症狀包括腹瀉、噁心、嘔吐、腹痛、發燒、寒顫等等。癌症病人發生小腸結腸炎相關的報告比較多見於困難梭狀桿菌 (Clostridiumdifficile) 感染及嗜中性球低下相關。Capecitabine (Xeloda®) 是一種原型藥，經由肝臟代謝後產生5-FU，因此可能產生腹瀉等副作用。
一名78 歲女性大腸癌患者，經手術後開始使用XELOX 作為輔助性化學治療，進行第三次療程後發生腹瀉，入院檢查排除感染及偽膜性腸炎，於入院後8 天安排無顯影劑的電腦斷層，發現小腸部份有大範圍腸壁變薄、腸液累積、air-fluid level 呈現小腸結腸炎現象，此時診斷改為疑似化學治療引起的小腸結腸炎。入院後8天開始靜脈給予麩醯胺酸及全靜脈營養。入院2 週後病人已無發燒與腹痛，入院三週後腹瀉次數已下降，由於腹瀉狀況持續改善，病人於入院後1 個月轉出加護病房，病人入院後2 個月後因病況好轉出院。
關於capecitabine 產生的小腸結腸炎案例報告中，非嗜中性球低下的案例相當少，麩醯胺酸是小腸細胞增生的能量來源，有相關研究指出補充麩醯胺酸可修復化學治療引起的腸道黏膜損傷，但對於降低化學治療相關腹瀉的效果仍有爭議。系統性回顧文獻可推論補充麩醯胺酸可減少化療引起腹瀉的天數，但對於嚴重程度則沒有顯著影響，因此補充麩醯胺酸對化療引起的小腸結腸炎可能有輔助改善的效果，但仍需要相關研究證明。
Introduction: Enterocolitis is a disease of bowel mucosa inflammation. Several chemotherapy agents have been reported to induce enterocolitis. Capecitabine is a pro-drug of 5-fluorouracil (5-FU) and enteorcolitis induced by capecitabine has been described in the literature.
Case: A 78 year-old woman was admitted to hospital due to diarrhea and nausea after third cycle of XELOX (capecitabine and oxaliplatin). Stool culture for Clostridium difficile, Shigella and Salmonela was negative. Family reported no dietary change and no other family member had diarrhea in the past week. Bowel thinning, air-fluid level and massive fluid retention through stomach to rectum were obvious on abdominal computed tomography (CT). Physician found erosion at stomach and several ulcers at duodenum on panendoscope but no lesions were compatible with inflammatory bowel disease. Patient was fasting due to diarrhea and total parenteral nutrition was started. Glutamine supplement was started for assisting mucosa healing.
Discussion: Capacitabine-related enterocolitis is a rare adverse effect. No specific treatment is indicated currently and management is mainly supportive care. Testing ihydropyrimidine dehydrogenase (DPD) mutation is unreliable for predicting gastrointestinal adverse effect induced by capecitabine. Glutamine has been used for chemotherapy-related diarrhea and one systematic review shows shortened duration of diarrhea. Glutamine is used in our patient and her condition was improved after glutamine administration. Glutamine might be beneficial for intestinal mucosa healing in chemotherapy-related enterocolitis but further study is needed.
