Thursday, October 16, 2008 Thomas W Cawood asks

Q: By what mechanism can heartburn persist following CMF/rad br ca treatment? No precondition.

By what mechanism can heartburn persist following CMF/Rad in a previous symptom free person?

At age 61 my wife was treated with CMF/rad for br ca. Previously she was reflux and abdominal pain free. Ca treatment abandoned early due to sores in mouth and other adverse symptoms. For 5.5 years we sought relief from multiple Specialists, multiple gastroendoscopes, refractory to medication. Then relief was offered by fundoplcation (loose partial). This was successful although heartburn returned but now controlled by PPI's. Abdominal pain was totally relieved. At the same time, in addition to chemo nausea, she developed refractory episodic nausea. Anti emetics from the cheapest to the most expensive, did not help. We saw a site on PubMed stating prophylaxis of tricyclic and reliever of sumatriptan (we added cyclizine-marzine) and for the past 6 years this treatment has been successful when episodes are experienced. Neurologist (3) said it is not migraine. (we think perhaps abdominal migriane but again this is contentious??). 24-hr pH monitoring showed acid and DeMeester score double normal, manometry showed LES and motility dysfunction. Also slow gut clearing (non-diab) now treated motilium. Cognitive deficits are present as well and so was severe photophobia. By what mechanism did a previously healthy person develop all these gut abnormalities all at once?.

Tom Cawood Auckland NZ.

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Answers (1)

Phyllis Johnson, Health Guide

10/17/08 7:24am

Thomas, I'm not an expert on digestive problems, but I can tell you that cancer treatment side effects can last for a long time. Ten years later, I still have nerve damage in my hands and feet. It took me about five years to get over the "chemo-brain" issues. My bench mark was being able to remember a phone number long enough to dial it without checking the paper three times. As you know, the chemo affects fast-growing cells which includes the cells that line the digestive system. Most of the time after chemo, the side effects get better within a year and often much sooner. No one knows why one chemo patient gets mouth sores and another has nausea while a third has joint problems and a fourth is virtually symptom free. I would think that a problem like persistent heartburn can be self-perpetuating once the irritation sets in. Maybe someone else with more expertise than I have can give you a more scientific explanation. I'm sorry that she has had such severe symptoms for so long.

Q: By what mechanism can heartburn persist following CMF/rad br ca treatment? No precondition.

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