{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T19:32:06Z","timestamp":1757619126294,"version":"3.44.0"},"reference-count":35,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2020,6,21]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Up to 90% of patients treated for pelvic cancers experience chronic gastrointestinal (GI) symptoms. This study characterises this patient cohort at a single centre, addressing a paucity of publications reporting \u2018real-world\u2019 experiences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Method<\/jats:title>\n                  <jats:p>Outpatient referrals, from oncology to the gastroenterology and nutrition services, at a tertiary London hospital from 2006 to 2016, were retrospectively identified. Patient characteristics, reported symptoms, investigations, diagnoses, response to therapeutics and follow-up were recorded.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 269 patients referred, 81% were within the latter 5\u2009years. A total of 260 patients had diagnoses of pelvic cancers (prostatic (52%), cervical (19%) and endometrial (19%)). Among 247 treated with radiotherapy, the median time from radiotherapy to symptom onset was 8 months. Common symptoms were rectal bleeding (51%), diarrhoea (32%), faecal urgency (19%) and pain (19%). Patients underwent a median of three investigations including lower GI endoscopy (86%), thyroid function tests (33%) and glucose hydrogen breath test (30%). Diagnoses included radiation proctopathy (39%), colonic polyps (16%), pelvic floor dysfunction (12%), bile acid malabsorption (BAM) (8%), small intestinal bacterial overgrowth (SIBO) (8%), vitamin D deficiency (7%) and iron deficiency (7%). Among 164 discharged patients, the time to discharge was 7 months, after a median of two appointments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This unique patient group reports a complex mix of symptoms and requires specialist review and consideration of often uninvestigated diagnoses (pelvic dysfunction, BAM, SIBO and nutritional deficiencies). Such patients are often overlooked, compared with those suffering many other chronic GI disorders. Further reports from non-dedicated centres treating patients with pelvic radiation disease will aid in understanding of secondary GI diagnoses and variation in practice.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/flgastro-2020-101430","type":"journal-article","created":{"date-parts":[[2020,8,11]],"date-time":"2020-08-11T17:48:44Z","timestamp":1597168124000},"page":"471-477","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Gastrointestinal consequences of cancer treatment: evaluation of 10 years\u2019 experience at a tertiary UK centre"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0421-3153","authenticated-orcid":false,"given":"Radha","family":"Gadhok","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Paulon","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chehkuan","family":"Tai","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomisin","family":"Olushola","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Barragry","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farooq","family":"Rahman","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Di Caro","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shameer","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,8,11]]},"reference":[{"key":"2025090709014710000_12.6.471.1","unstructured":"Cancer Research UK . Lifetime risk estimates based on office for national statistics (ONS) 2016-based life expectancies and population projections, 2019. Available: https:\/\/www.cancerresearchuk.org\/health-professional\/data-and-statistics"},{"key":"2025090709014710000_12.6.471.2","doi-asserted-by":"crossref","unstructured":"Hoskin P . Radiotherapy in practice: external beam therapy. 3rd Edn. Oxford University Press, 2019.","DOI":"10.1093\/med\/9780198786757.001.0001"},{"key":"2025090709014710000_12.6.471.3","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2016.304"},{"key":"2025090709014710000_12.6.471.4","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2014.46"},{"key":"2025090709014710000_12.6.471.5","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1038\/bjc.2011.417","article-title":"New pathways of care for cancer survivors: adding the numbers","volume":"105 Suppl 1","author":"Maher","year":"2011","journal-title":"Br J Cancer"},{"key":"2025090709014710000_12.6.471.6","unstructured":"The National Cancer Survivorship Initiative Vision . Department of health, Macmillan cancer support, NHS improvement 2010, 2010."},{"key":"2025090709014710000_12.6.471.7","unstructured":"Cancer Research UK . United Kingdom cancer incidence 2011, summary counts, 2014. Available: http:\/\/www.cancerresearchuk.org\/healthprofessional\/cancer-statistics\/incidence [Accessed Oct 2019]."},{"key":"2025090709014710000_12.6.471.8","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.clon.2011.04.002","article-title":"Late-Onset bowel dysfunction after pelvic radiotherapy: a national survey of current practice and opinions of clinical oncologists","volume":"23","author":"Henson","year":"2011","journal-title":"Clin Oncol"},{"key":"2025090709014710000_12.6.471.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.10.009"},{"key":"2025090709014710000_12.6.471.10","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/CCO.0000000000000215","article-title":"Management of toxicities following pelvic irradiation for gynaecological cancers","volume":"27","author":"Fernandes","year":"2015","journal-title":"Curr Opin Oncol"},{"key":"2025090709014710000_12.6.471.11","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.eururo.2018.12.003","article-title":"Pelvic complications after prostate cancer radiation therapy and their management: an international collaborative narrative review","volume":"75","author":"Matta","year":"2019","journal-title":"Eur Urol"},{"key":"2025090709014710000_12.6.471.12","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.ygyno.2010.10.017","article-title":"Late Gi and bladder toxicities after radiation for uterine cancer","volume":"120","author":"Samper-Ternent","year":"2011","journal-title":"Gynecol Oncol"},{"key":"2025090709014710000_12.6.471.13","doi-asserted-by":"crossref","DOI":"10.1007\/s11934-015-0547-1","article-title":"Quality of life outcomes for bladder cancer patients undergoing bladder preservation with radiotherapy","volume":"16","author":"Feuerstein","year":"2015","journal-title":"Curr Urol Rep"},{"key":"2025090709014710000_12.6.471.14","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6602552"},{"key":"2025090709014710000_12.6.471.15","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/613810"},{"key":"2025090709014710000_12.6.471.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2007.06.005"},{"key":"2025090709014710000_12.6.471.17","doi-asserted-by":"publisher","DOI":"10.3109\/0284186X.2013.873140"},{"key":"2025090709014710000_12.6.471.18","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1667\/RR14272.1","article-title":"Gi consequences of cancer treatment: a clinical perspective","volume":"185","author":"Andreyev","year":"2016","journal-title":"Radiat Res"},{"key":"2025090709014710000_12.6.471.19","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/j.ejca.2008.07.018","article-title":"Small bowel bacterial overgrowth and lactose intolerance during radical pelvic radiotherapy: an observational study","volume":"44","author":"Wedlake","year":"2008","journal-title":"Eur J Cancer"},{"key":"2025090709014710000_12.6.471.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2009.11.027"},{"key":"2025090709014710000_12.6.471.21","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/CCO.0000000000000215","article-title":"Management of toxicities following pelvic irradiation for gynaecological cancers","volume":"27","author":"Fernandes","year":"2015","journal-title":"Curr Opin Oncol"},{"key":"2025090709014710000_12.6.471.22","first-page":"2881","article-title":"Outcomes from treating bile acid malabsorption using a multidisciplinary approach","volume":"23","author":"Gupta","year":"2015","journal-title":"Support Care Cancer"},{"key":"2025090709014710000_12.6.471.23","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.16-3-240"},{"key":"2025090709014710000_12.6.471.24","first-page":"2255","article-title":"Structured gastroenterological intervention and improved outcome for patients with chronic gastrointestinal symptoms following pelvic radiotherapy","volume":"21","author":"Henson","year":"2013","journal-title":"Support Care Cancer"},{"key":"2025090709014710000_12.6.471.25","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.12968\/bjon.2017.26.4.S15","article-title":"Late gastrointestinal effects of pelvic radiation: a nurse-led service","volume":"26","author":"Ludlow","year":"2017","journal-title":"Br J Nurs"},{"key":"2025090709014710000_12.6.471.26","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1080\/0284186X.2018.1562211","article-title":"Clinical evaluation and treatment of chronic bowel symptoms following cancer in the colon and pelvic organs","volume":"58","author":"Larsen","year":"2019","journal-title":"Acta Oncol"},{"key":"2025090709014710000_12.6.471.27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61648-7"},{"key":"2025090709014710000_12.6.471.28","doi-asserted-by":"crossref","first-page":"225","DOI":"10.3109\/0284186X.2012.746467","article-title":"Managing the consequences of cancer treatment and the English National cancer survivorship initiative","volume":"52","author":"Maher","year":"2013","journal-title":"Acta Oncol"},{"key":"2025090709014710000_12.6.471.29","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2011-300563"},{"key":"2025090709014710000_12.6.471.30","first-page":"2129","article-title":"Gastrointestinal symptoms after pelvic radiotherapy: a national survey of Gastroenterologists","volume":"20","author":"Henson","year":"2012","journal-title":"Support Care Cancer"},{"key":"2025090709014710000_12.6.471.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2000.03368.x"},{"key":"2025090709014710000_12.6.471.32","first-page":"111","article-title":"Antibiotic therapy in small intestinal bacterial overgrowth: rifaximin versus metronidazole","volume":"13","author":"Lauritano","year":"2009","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025090709014710000_12.6.471.33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/3087603","article-title":"Efficacy and safety of argon plasma coagulation for hemorrhagic chronic radiation Proctopathy: a systematic review","volume":"2018","author":"Peng","year":"2018","journal-title":"Gastroenterol Res Pract"},{"key":"2025090709014710000_12.6.471.34","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/S1470-2045(15)00461-1","article-title":"Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trial","volume":"17","author":"Glover","year":"2016","journal-title":"Lancet Oncol"},{"key":"2025090709014710000_12.6.471.35","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1017\/S0029665118000101","article-title":"Nutritional strategies to prevent gastrointestinal toxicity during pelvic radiotherapy","volume":"77","author":"Wedlake","year":"2018","journal-title":"Proc Nutr Soc"}],"container-title":["Frontline Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/flgastro-2020-101430","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T16:02:13Z","timestamp":1757260933000},"score":1,"resource":{"primary":{"URL":"https:\/\/fg.bmj.com\/lookup\/doi\/10.1136\/flgastro-2020-101430"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,11]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,10,7]]},"published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1136\/flgastro-2020-101430"],"URL":"https:\/\/doi.org\/10.1136\/flgastro-2020-101430","relation":{},"ISSN":["2041-4137","2041-4145"],"issn-type":[{"type":"print","value":"2041-4137"},{"type":"electronic","value":"2041-4145"}],"subject":[],"published":{"date-parts":[[2020,8,11]]}}}