{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:18:18Z","timestamp":1784297898335,"version":"3.55.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>There is rising utilization of immune checkpoint inhibitors (ICI) for a growing number of metastatic malignancies. While gastrointestinal side effects of ICI are common, isolated ICI-induced enteritis leading to small bowel hemorrhage is rare.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 71-year-old man with a previously resected right colon adenocarcinoma on atezolizumab and recently treated <jats:italic>Clostridioides difficile<\/jats:italic> presented with acute on chronic abdominal pain and non-bloody diarrhea. A CT scan revealed enteritis of the duodenum and jejunum without colitis. Initial endoscopic work-up revealed many clean-based non-bleeding duodenal ulcers to the third portion of the duodenum and normal rectosigmoid mucosa. The patient initially improved on steroids but was readmitted on day after discharge with hematochezia and hemorrhagic shock. Repeat CT showed improvement in enteritis; however, repeat push enteroscopy revealed multiple duodenal and jejunal ulcers, two with visible vessels requiring endoscopic intervention. He continued to have significant hemorrhage requiring transfusions despite IV methylprednisolone. Conventional angiogram revealed multiple sites of active extravasation, and he underwent small bowel resection\u00a0and subsequent IR embolization due to persistent bleeding. He\u00a0was then started on infliximab 10\u00a0mg\/kg with resolution of his small bowel hemorrhage and diarrhea.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Severe isolated ICI-enteritis is rare and can lead to clinically significant gastrointestinal hemorrhage. Patients with severe ICI-enteritis on endoscopy should be carefully monitored for steroid refractory disease for consideration of step-up therapy such as infliximab.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-021-01915-1","type":"journal-article","created":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T14:03:37Z","timestamp":1631023417000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Small bowel hemorrhage from check point inhibitor enteritis: a case report"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6555-2584","authenticated-orcid":false,"given":"Kellie","family":"Young","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emery","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emerson","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Brinkerhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,7]]},"reference":[{"key":"1915_CR1","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1016\/j.cgh.2020.01.033","volume":"18","author":"M Collins","year":"2020","unstructured":"Collins M, Soularue E, Marthey L, Carbonnel F. Management of patients with immune checkpoint inhibitor-induced enterocolitis: a systemic review. Clin Gastroenterol Hepatol. 2020;18:1393\u2013403.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"11","key":"1915_CR2","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.2217\/imt.15.87","volume":"7","author":"O Abdel-Rahman","year":"2015","unstructured":"Abdel-Rahman O, ElHalawani H, Fouad M. Risk of gastrointestinal complications in cancer patients treated with immune checkpoint inhibitors: a meta-analysis. Immunotherapy. 2015;7(11):1213\u201327.","journal-title":"Immunotherapy"},{"issue":"38","key":"1915_CR3","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1200\/EDBK_100013","volume":"23","author":"S Grover","year":"2018","unstructured":"Grover S, Rahma OE, Hashemi N, Lim RM. Gastrointestinal and hepatic toxicities of checkpoint inhibitors: algorithms for management. Am Soc Clin Oncol Educ Book. 2018;23(38):13\u20139.","journal-title":"Am Soc Clin Oncol Educ Book"},{"issue":"4","key":"1915_CR4","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1111\/his.13118","volume":"70","author":"RS Gonzalez","year":"2017","unstructured":"Gonzalez RS, Salaria SN, Bohannon CD, Huber AR, Feely MM, Shi C. PD-1 inhibitor gastroenterocolitits: case series and appraisal of \u2018immunomodulatory gastroenterocolitis.\u2019 Histopathology. 2017;70(4):558\u201367.","journal-title":"Histopathology"},{"key":"1915_CR5","doi-asserted-by":"publisher","first-page":"2860","DOI":"10.1093\/annonc\/mdx403","volume":"28","author":"M Collins","year":"2017","unstructured":"Collins M, Michot JM, Danlos FX, Mussini C, Soularue E, Mateus C, Loirat D, Buisson A, Rosa I, Lambotte O, Laghouati S, Chaput N, Coutzac C, Voisin AL, Soria JC, Marabelle A, Champiat S, Robert C, Carbonnel F. Inflammatory gastrointestinal diseases associated with PD-1 blockade antibodies. Ann Oncol. 2017;28:2860\u20135.","journal-title":"Ann Oncol"},{"issue":"191","key":"1915_CR6","doi-asserted-by":"publisher","first-page":"E1106","DOI":"10.1503\/cmaj.190244","volume":"7","author":"D Sanders","year":"2019","unstructured":"Sanders D, Webber D, Chatur N. Enteritis with immune checkpoint inhibitor use. CMAJ. 2019;7(191):E1106.","journal-title":"CMAJ"},{"key":"1915_CR7","doi-asserted-by":"publisher","first-page":"17","DOI":"10.14309\/crj.2018.17","volume":"5","author":"P Diana","year":"2018","unstructured":"Diana P, Mankongpaisarnrung C, Atkins MB, Zeck JC, Charabaty A. Emerging role of vedolizumab in managing refractory immune checkpoint inhibitor-inducedenteritis. ACG Case Rep J. 2018;5:17.","journal-title":"ACG Case Rep J"},{"issue":"3","key":"1915_CR8","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1159\/000452403","volume":"9","author":"M Messmer","year":"2016","unstructured":"Messmer M, Upreti S, Tarabishy Y, Mazumder N, Chowdhury R, Yarchoan M, Holdhoff M. Ipilimumab-induced enteritis without colitis: a new challenge. Case Rep Oncol. 2016;9(3):705\u201313.","journal-title":"Case Rep Oncol"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-01915-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-021-01915-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-01915-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T14:04:05Z","timestamp":1631023445000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-021-01915-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,7]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1915"],"URL":"https:\/\/doi.org\/10.1186\/s12876-021-01915-1","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,7]]},"assertion":[{"value":"26 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient and his wife for publication of this case report. A copy of the written consent is available for review if requested.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"345"}}