{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:08:24Z","timestamp":1790467704783,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100012139","name":"Royal Marsden NHS Foundation Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012139","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but are associated with gastrointestinal (GI) immune\u2010related adverse events (IrAEs). GI dysautonomia is a rare IrAE due to enteric nervous system dysfunction with\/without generalized autonomic failure. Here, we present a case series of GI dysautonomia following ICI therapy and conduct a systematic review of the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present three patients with ICI\u2010induced GI dysautonomia referred to our tertiary ICI\u2010neurotoxicity service. A systematic review was conducted in OVID, Cochrane, and Scopus until December 2024 for studies evaluating ICI\u2010induced GI dysautonomia, including clinical presentation, treatment choice, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>\n                      Three male patients were treated with ICIs for melanoma (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092) and chondrosarcoma. Severe GI symptoms developed at seven\u2009years, two months, and three\u2009weeks from treatment initiation at ages 77, 60, and 57\u2009years old, respectively. All three had panenteric involvement with additional autonomic dysfunction. Two patients had poor outcomes with enteral and parenteral nutrition dependence, respectively, and died from GI complications. The third case responded well to prolonged high\u2010dose corticosteroids and mycophenolate maintenance. On systematic review, 18 individual cases were reported in 15 publications, with the onset of GI dysautonomia at a mean time of 13.6\u2009weeks (SD 14.3) from ICI exposure. Corticosteroids were the primary treatment in 72% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913), with a limited duration and low (&lt;\u20091\u2009mg\/kg\/day prednisolone equivalent) dose used in 46.2% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096\/13). There was GI recovery in 38.5% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095) and mortality in 47.0% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098; 1 missing).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ICI\u2010induced GI dysautonomia is a potentially life\u2010threatening IrAE requiring early recognition and effective immunosuppression to optimize outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70212","type":"journal-article","created":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T12:40:07Z","timestamp":1764506407000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Gastrointestinal Dysautonomia After Immune Checkpoint Inhibitor Therapy: A Case Series and Systematic Review"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7114-2757","authenticated-orcid":false,"given":"S.","family":"Sennf\u00e4lt","sequence":"first","affiliation":[{"name":"Department of Neurology National Hospital for Neurology and Neurosurgery  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Norton","sequence":"additional","affiliation":[{"name":"Digestive Disease &amp; Surgery Institute, Cleveland Clinic London  London UK"},{"name":"Centre for Obesity Research University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. T.","family":"Jarjis","sequence":"additional","affiliation":[{"name":"Faculty of Medicine &amp; Dentistry Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Keen","sequence":"additional","affiliation":[{"name":"Department of Oncology Royal Free Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Sheri","sequence":"additional","affiliation":[{"name":"Department of Oncology Royal Free Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Hatipoglu","sequence":"additional","affiliation":[{"name":"Sarcoma Unit Royal Marsden Hospital  London UK"},{"name":"Institute of Cancer Research  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. L.","family":"Jones","sequence":"additional","affiliation":[{"name":"Sarcoma Unit Royal Marsden Hospital  London UK"},{"name":"Institute of Cancer Research  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Emmanuel","sequence":"additional","affiliation":[{"name":"Neurogastroenterology Service National Hospital for Neurology and Neurosurgery  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Nathan","sequence":"additional","affiliation":[{"name":"Department of Oncology Mount Vernon Cancer Centre  Northwood UK"},{"name":"Department of Oncology University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine Hammersmith Hospital  London UK"},{"name":"Department of Renal Medicine Cleveland Clinic London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Kaski","sequence":"additional","affiliation":[{"name":"Department of Neurology National Hospital for Neurology and Neurosurgery  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Nortley","sequence":"additional","affiliation":[{"name":"Department of Neurology National Hospital for Neurology and Neurosurgery  London UK"},{"name":"Neurosciences Institute Cleveland Clinic London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Iodice","sequence":"additional","affiliation":[{"name":"Department of Neurology National Hospital for Neurology and Neurosurgery  London UK"},{"name":"Department of Translational Neuroscience and Stroke University College London  London UK"},{"name":"Autonomic Unit National Hospital for Neurology and Neurosurgery  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Zarate\u2010Lopez","sequence":"additional","affiliation":[{"name":"Digestive Disease &amp; Surgery Institute, Cleveland Clinic London  London UK"},{"name":"Neurogastroenterology Service National Hospital for Neurology and Neurosurgery  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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