[Management of chemotherapy induced diarrhea]

Chemotherapy-induced diarrhea (CID) became first apparent during clinical studies on the combination of 5-FU with leucovorin and, furthermore, with irinotecan in the treatment of metastatic colorectal carcinoma. Bowel dysfunctions, such as diarrhea and constipation, can be a disturbing side effect in chemotherapy that may result not only in significant physical and emotional distress for the patients and care givers, but also in diminished therapeutic efficacy due to dose limitations and treatment interruptions. Besides leucocytopenia, granulocytopenia and thrombocytopenia, CID is considered one of the main dose-limiting toxicities associated with chemotherapy agents, especially in treatment regimens for colorectal cancer and can even be life-threatening. Early recognition and treatment can prevent the morbidity and mortality associated with CID. The most commonly used assessment tool is the National Cancer Institute Common Toxicity Criteria for Grading the Severity of Diarrhea. In this review, we will concentrate on the modern management of CID. Traditional pharmacological management of CID has included mainly non-specific agents. For patients who are refractory to non-specific therapy, there are more sophisticated, specific therapeutic agents available.