Treatment of capecitabine-induced enterocolitis with cholestyramine

Non-neutropenic enterocolitis is an uncommon side effect of chemotherapeutic agents for solids tumors. Its incidence is unknown. Capecitabine is a cytotoxic agent and an oral prodrug of 5-Fluorouracil (5-FU). It is known to cause diarrhea in up to 67% of patients [11% of which are, common terminology criteria (CTC) grade 3 to 4] which often necessitates dose limitation or discontinuing the medication. Cytotoxic chemotherapy agents have a direct effect on gastrointestinal (GI) mucosa causing inflammation, edema, ulceration and atrophy. Chemotherapy induced diarrhea can cause depletion of fluids and electrolytes, malnutrition, dehydration and hospitalization, all of which can lead to cardiovascular compromise and death. Current recommendations for treatment are mainly limited to IV hydration, opioids, and octreotide. Cholestyramine does not appear to have been reported previously as a potential treatment option for chemotherapy induced enterocolitis or diarrhea. Here we report one case of capecitabine induced non-neutropenic enterocolitis that was treated effectively using cholestyramine.