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Intractable diarrhoea with a lung neuroendocrine tumour
  1. Craig Gouldthorpe and
  2. Lucy Roth
  1. Palliative Medicine, Teesside Hospice Care Foundation, Middlesbrough, UK
  1. Correspondence to Dr Craig Gouldthorpe, Palliative Medicine, Teesside Hospice Care Foundation, Middlesbrough, UK; cgouldthorpe{at}nhs.net

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Abstract

Patients with neuroendocrine tumours are at risk of developing Carcinoid Syndrome. This may result in symptoms such as diarrhoea and flushing. We present a case of a lady with known Crohn’s disease and an atypical lung neuroendocrine tumour, who developed intractable diarrhoea. Multiple specific and non-specific pharmacological approaches failed to control her diarrhoea. Upon cessation of such treatments, her symptoms did not worsen. The case highlights the need for further research into the management of diarrhoea in this context, and the need to review and deprescribe ineffective treatments.

Introduction

Multiple causes of chronic diarrhoea exist, including gastrointestinal cancer or inflammation, pancreatic insufficiency, malabsorption and motility disorders.1 Diet, coeliac disease, medication and irritable bowel syndrome may also contribute.1 Following a focused history and examination, initial investigations may include inflammatory or infective markers in the blood and stool and serological tests for coeliac disease, hyperthyroidism and anaemia.1 Concerning features, warranting secondary care referral and further investigation, include unexplained change to bowel habit, unexplained weight loss and blood in the stool.1 Specific management approaches exist for identified pathologies. Examples include antibiotics for small bowel bacterial overgrowth and bile acid binders for bile acid malabsorption.2

In cases of poor response to targeted treatment, or an unclear diagnosis, empirical treatment aimed at symptom management may be appropriate.2 Examples of non-specific approaches include loperamide, an opiate with mu receptor agonistic activity, and serotonin type 3 receptor antagonists, which slow gut transit and increase fluid absorption.2 More potent opioids may be used in severe cases.2 Treatments can also vary in specificity, such as cholestyramine for bile acid malabsorption which has …

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Footnotes

  • Twitter @cgouldt

  • Contributors Original article was written by CG with editorial input for final manuscript from LR. Consent was gained from and article was submitted by CG. Both authors were involved in the care of the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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