| Summary: | Oesophagogastric (OG) cancer patients are at risk of developing persistent gastrointestinal (GI) symptoms and/or malnutrition. It is possible that GI symptoms co-exist with malnutrition rather than simply occurring in isolation. Eighty patients with OG cancer were recruited to a prospective observational cohort study to explore this relationship at the point of diagnosis and at 3- and 12 months post-diagnosis (Chapter 3). At 12 months, GI symptoms and malnutrition persisted or developed in 71.9% and 59.6% respectively. High symptom burden tended to be associated with poorer nutritional status and low symptom burden tended to be associated with better nutritional status at each time point. An effective nutritional screening tool is essential for detecting malnutrition in the OG oncology setting. A validation study of the Malnutrition Universal Screening Tool against an accepted standard (Patient Generated Subjective Global Assessment) was undertaken (Chapter 4). The screening tool had a sensitivity of 61% and a specificity of 74% and thus, is not suitable for use in this setting. Theoretically, as a consequence of the treatments received, patients with cancer are at high-risk for the development of small intestinal bacterial overgrowth (SIBO), a condition that implies abnormal bacterial colonisation of the proximal small bowel. The incidence of SIBO after diagnosis was measured in a sub-group of the OG cancer cohort (n= 17) and was found to be 82.4% (Chapter 3). There is no gold-standard test for SIBO and a new, accurate diagnostic tool would represent a major development. A cohort of 200 patients previously treated for cancer and undergoing testing for suspected SIBO were recruited (Chapter 5). The metabolic profile of their urine samples was assessed (using metabolomics technology) to establish whether any metabolite(s) could separate individuals with and without SIBO. N-acethylglutamine, a modified amino acid, showed some ability to separate the two groups.
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