Dysphagia, reflux, and hiccups are common gastrointestinal symptoms in cancer patients. They may arise either from the underlying disease or as an acute or late complication of treatment and is particularly common in patients with upper gastrointestinal and head and neck malignancy. These symptoms can have serious adverse effects, including on nutritional status and quality of life.
In patients experiencing dysphagia as an acute side effect of chemotherapy or radiotherapy, most consistently seen in patients undergoing treatment for head and neck and advanced lung cancer, aggressive nutritional and supportive care, including feeding tube insertion, may be required. Late toxicity such as esophageal stricture may require endoscopic dilatation. For patients with direct tumor involvement such as esophageal cancer, optimal management options include supportive measures (hydration, nutritional support), mechanical measures (dilatation, endoscopic stenting), and antineoplastic measures (external beam radiotherapy, brachytherapy, or chemotherapy).
Gastroesophageal reflux can arise as a result of malignant involvement of the stomach or esophagus, esophagitis and gastritis due to chemotherapy, radiotherapy, supportive medications and candidiasis of Helicobacter pylori infection. Management including dietary modifications and empirical treatment with a proton pump inhibitor represent the mainstay of therapy.
Persistent hiccups can indicate serious underlying pathology including malignant involvement of the gastrointestinal tract. The evidence in support of treatment efficacy is extremely sparse. A rational approach involves treating the underlying cause, removing exacerbating factors, and using pharmacological interventions with chlorpromazine, baclofen, or gabapentin being common agents of choice.
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Maltoni M, Caraceni A, Brunelli C, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations–a study by the Steering Committee of the European Association for Palliative Care. Journal of Clinical Oncology 2005;23:6240–6248.PubMedCrossRefGoogle Scholar
Tong H, Isenring E, Yates P. The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients. Supportive Care in Cancer 2009;17:83–90.PubMedCrossRefGoogle Scholar
Walsh D, Donnelly S, Rybicki L. The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Supportive Care in Cancer 2000;8:175–179.PubMedCrossRefGoogle Scholar
Jimenez-Gordo AM, Feliu J, Martinez B, et al. Descriptive analysis of clinical factors affecting terminally ill cancer patients. Supportive Care in Cancer 2009;17:261–269.PubMedCrossRefGoogle Scholar
Javle M, Ailawadhi S, Yang GY, et al. Palliation of malignant dysphagia in esophageal cancer: a literature-based review [see comment]. The Journal of Supportive Oncology 2006;4:365–373.PubMedGoogle Scholar
Garcia-Peris P, Paron L, Velasco C, et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clinical Nutrition 2007;26:710–717.PubMedCrossRefGoogle Scholar
Nguyen NP, Smith HJ, Sallah S, et al. Evaluation and management of swallowing dysfunction following chemoradiation for head and neck cancer. Current Opinion in Otolaryngology & Head and Neck Surgery 2007;15:130–133.CrossRefGoogle Scholar
Goyal RK, Chaudhury A, Goyal RK, et al. Physiology of normal esophageal motility. Journal of Clinical Gastroenterology 2008;42:610–619.PubMedCrossRefGoogle Scholar
Mellow MH, Pinkas H. Endoscopic laser therapy for malignancies affecting the esophagus and gastroesophageal junction. Analysis of technical and functional efficacy. Archives of Internal Medicine 1985;145:1443–1446.PubMedCrossRefGoogle Scholar
Wheeler-Hegland KP, Ashford JP, Frymark TM, et al. Evidence-based systematic review: oropharyngeal dysphagia behavioral treatments. Part II-Impact of dysphagia treatment on normal swallow function. Journal of Rehabilitation Research and Development 2009;46:185.PubMedCrossRefGoogle Scholar
Yakoub D, Fahmy R, Athanasiou T, et al. Evidence-based choice of esophageal stent for the palliative management of malignant dysphagia. World Journal of Surgery 2008;32:1996–2009.PubMedCrossRefGoogle Scholar
Sur RK, Levin CV, Donde B, et al. Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma–an International Atomic Energy Agency study.[see comment]. International Journal of Radiation Oncology, Biology, Physics 2002;53:127–133.PubMedCrossRefGoogle Scholar
Sreedharan A, Harris K, Crellin A, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database of Systematic Reviews 2009;(4):CD005048.Google Scholar
Sur R, Donde B, Falkson C, et al. Randomized prospective study comparing high-dose-rate intraluminal brachytherapy (HDRILBT) alone with HDRILBT and external beam radiotherapy in the palliation of advanced esophageal cancer. Brachytherapy 2004;3:191–195.PubMedCrossRefGoogle Scholar
Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. [see comment]. American Journal of Gastroenterology 2006;101:1900–1920; quiz 1943.Google Scholar
Talley NJ, Talley NJ. How to manage the difficult-to-treat dyspeptic patient. Nature Clinical Practice Gastroenterology and Hepatology 2007;4:35–42.PubMedCrossRefGoogle Scholar
Neale JC, Goulden JW, Allan SG, et al. Esophageal stents in malignant dysphagia: a two-edged sword? Journal of Palliative Care 2004;20:28–31.PubMedGoogle Scholar
Rose J, Rodrigues G, Yaremko B, et al. Systematic review of dose-volume parameters in the prediction of esophagitis in thoracic radiotherapy. Radiotherapy and Oncology 2009;91:282–287.PubMedCrossRefGoogle Scholar
Yuan Y, Hunt RH, Yuan Y, et al. Evolving issues in the management of reflux disease? Current Opinion in Gastroenterology 2009;25:342–351.PubMedCrossRefGoogle Scholar
van Pinxteren B, Numans ME, Bonis PA, Lau J. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database of Systematic Reviews 2006;19;3:CD002095. Review.Google Scholar
Moayyedi P, Soo S, Deeks J, Delaney B, Innes M, Forman D. Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database of Systematic Reviews 2006;18;(4):CD001960. Review.Google Scholar
Donnellan C, Sharma N, Preston C, Moayyedi P. Medical treatments for the maintenance therapy of reflux oesophagitis and endoscopic negative reflux disease. Cochrane Database of Systematic Reviews 2005;18;(2):CD003245. Review. Update in: Cochrance Database of Systematic Reviews 2010;2:CD003245. PMID: 15846653.Google Scholar
Agar M, Webster R, Lacey J, et al. The use of subcutaneous omeprazole in the treatment of dyspepsia in palliative care patients. Journal of Pain and Symptom Management 2004;28:529–531.PubMedCrossRefGoogle Scholar
Algara M, Rodriguez N, Vinals P, et al. Prevention of radiochemotherapy-induced esophagitis with glutamine: results of a pilot study. International Journal of Radiation Oncology, Biology, Physics 2007;69:342–349.PubMedCrossRefGoogle Scholar
Sasse AD, Clark LG, Sasse EC, et al. Amifostine reduces side effects and improves complete response rate during radiotherapy: results of a meta-analysis. International Journal of Radiation Oncology, Biology, Physics 2006;64:784–791.PubMedCrossRefGoogle Scholar
Liaw CC, Wang CH, Chang HK, et al. Gender discrepancy observed between chemotherapy-induced emesis and hiccups. Supportive Care in Cancer 2001;9:435–441.PubMedCrossRefGoogle Scholar
Smith HS, Busracamwongs A. Management of hiccups in the palliative care population. American Journal of Hospice and Palliative Medicine 2003;20:149–154.PubMedCrossRefGoogle Scholar
Ramirez FC, Graham DY. Treatment of intractable hiccup with baclofen: results of a double-blind randomized, controlled, cross-over study. American Journal of Gastroenterology 1992;87:1789–1791.PubMedGoogle Scholar
Dore MP, Pedroni A, Pes GM, et al. Effect of antisecretory therapy on atypical symptoms in gastroesophageal reflux disease. Digestive Diseases and Sciences 2007;52:463–468.PubMedCrossRefGoogle Scholar
Petroianu G, Hein G, Petroianu A, et al. Idiopathic chronic hiccup: combination therapy with cisapride, omeprazole, and baclofen. Clinical Therapeutics 1997;19:1031–1038.PubMedCrossRefGoogle Scholar
Hernández JL, Pajarón M, García-Regata O, et al. Gabapentin for intractable hiccup. The American Journal of Medicine 2004;117:279–281.PubMedCrossRefGoogle Scholar
Kranke P, Eberhart LH, Morin AM, et al. Treatment of hiccup during general anaesthesia or sedation: a qualitative systematic review. European Journal of Anaesthesiology 2003;20:239–244.PubMedCrossRefGoogle Scholar
Dobelle WH. Use of breathing pacemakers to suppress intractable hiccups of up to thirteen years duration. ASAIO Journal 1999;45:524–525.PubMedCrossRefGoogle Scholar