Immune Checkpoint Inhibitor-Mediated Colitis
Grade of Disease Severity:
• G1: Increase < 4 BMs/day over baseline; mild increase ostomy output over baseline
• G2: Increase 4-6 BMs/day over baseline; mod increase ostomy output over baseline
• G3: Increase > 7 BMs/day over baseline; severe increase ostomy output over baseline; incontinence; hospitalization; limiting self-care ADL
• G4: Life-threatening consequences; urgent intervention indicated
Diagnostic Evaluation: G2-4
• Consult GI
• Labs: CBC, CMP, TSH, ESR, CRP
• Stool: C. Diff, Stool cx, O&P, GPP, etc.
• Endoscopy (Flex Sig or Colon +EGD):
- Random Bx and IHC staining r/oCMV
- G2: consider early in course to prognosticate
- G3/4: urgent
• Imaging: Cross-sectional Imaging (MR/CT) if c/f complication
• Consider: HAV/HBV serologies, HIV screen, IGRAs, fecal calprotectin or lactoferrin
Dr. Waseem Ahmed @Waseem_AhmedMD
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