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Checkpoint Inhibitor-Induced Enterocolitis

When the immune system attacks the lining of the bowel/intestines as a result of checkpoint inhibitor therapy, the condition is called checkpoint inhibitor-induced enterocolitis, or ICI-induced enterocolitis.

Checkpoint inhibitor therapy is a type of cancer treatment which involves activating the immune system in order to locate and attack cancer cells more effectively. However, though checkpoint inhibitor therapy can be effective to treat cancer, it can also cause adverse immune-related side effects, including autoimmune reactions to other, healthy parts of the body. 

ICI-induced enterocolitis shares symptoms with other forms of bowel inflammation, though it differs in terms of cause and onset. Symptoms may include diarrhoea (sometimes bloody), abdominal pain and cramping, urgency, tenesmus (the feeling of needing to go to the toilet though the bowel is empty) and in severe cases fever and weight loss. ICI-induced enterocolitis affects the whole intestinal tract and can occur a few weeks or months after starting checkpoint inhibitor therapy.

Endoscopy (examination of the interior of the intestinal tract) and biopsies (examination of tissue samples taken during endoscopies) are often valuable when diagnosing suspected ICI-induced enterocolitis. Before diagnosing ICI-induced enterocolitis, other causes for the symptoms, such as infections, must be ruled out.

ICI-induced enterocolitis often resolves with treatment. Treatment for the condition varies on the severity of inflammation and symptoms - milder forms of ICI-induced colitis are typically managed with corticosteroids, whereas more severe cases sometimes require biological agents, and the checkpoint inhibitor therapy may need to be temporarily or permanently discontinued. Supportive care and close monitoring by a multidisciplinary team is a cornerstone of treatment for patients with ICI-induced enterocolitis at Karolinska.

Gastroenterology

Gastroenterology includes both upper abdominal surgery and lower abdominal surgery Gastroenterology