FIGURE 1.
FIGURE 2.
FIGURE 3.
CTCAE gastrointestinal toxicity levels of ICPI2,4
| Grade | Diarrhoea | Colitis |
|---|---|---|
| 1 | Increase in frequency of bowel movements < 4x above baseline; mild increase in ejection via stoma | Asymptomatic; clinical or diagnostic observation only; no action required |
| 2 | Increase in frequency of bowel movements 4–6x above baseline; moderate increase in ejection via stoma | Abdominal pain; mucus or blood in stool |
| 3 | Increase in frequency of bowel movements ≥ 7x above baseline, incontinence, need for hospitalisation, impaired daily self-care; marked increase in ejection via stoma | Severe or persistent abdominal pain; change in bowel movements; fever, ileus, peritoneal irritation; medical intervention required |
| 4 | Life-threatening consequences; need for urgent action | Life-threatening consequences; need for urgent action |
| 5 | Death | Death |
Mayo endoscopic score14
| Mayo score 0 | Mayo score 1 | Mayo score 2 | Mayo score 3 | |
|---|---|---|---|---|
| Disease activity | Inactive disease | Mild activity erythema, decreased vascular pattern, mild friability | Medium activity marked erythema, absent vascular pattern, friability, erosions | High activity |
| Features | normal mucosa | spontaneous bleeding, ulceration |
Set of diagnostic tests1,2,3
| Stool tests |
| Stool culture for pathogenic bacteria (e.g. Yersinia) and viruses |
| Clostridium difficile toxin |
| Parasites and parasite eggs |
| Pancreatic elastase |
| Inflammatory markers (calprotectin, lactoferrin) |
| PCR for CMV |
| Blood tests |
| Complete blood count |
| Biochemical tests (liver tests, renal function tests, amylase, lipase, albumin,...) |
| TSH |
| Inflammatory markers (CRP, ESR) |
| Serology for celiac disease (total IgA, tTG) |
| HIV serology |
| Imaging |
| CT scan of the abdomen (for severe abdominal pain) |
| Endoscopy of the lower GI tract (in all or at least patients with CTCAE grade ≥ 2) |
| Investigations before immunosuppressive/biological treatment |
| Serology for HAV, HBV and HCV, HIV |
| Quantiferon test |
| Chest X-ray |