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Table 5. Digestive Tract Late Effects

Predisposing Therapy Gastrointestinal Effects Health Screening/Interventions 
GVHD = graft-versus-host disease; KUB = kidneys, ureter, bladder (plain abdominal radiograph).
Radiation impacting esophagus; hematopoietic cell transplantation with any history of chronic GVHDEsophageal strictureHistory: dysphagia, heart burn
Esophageal dilation, antireflux surgery
Radiation impacting bowelChronic enterocolitis; fistula; stricturesHistory: nausea, vomiting, abdominal pain, diarrhea
Serum protein and albumin levels yearly in patients with chronic diarrhea or fistula
Surgical and/or gastroenterology consultation for symptomatic patients
Radiation impacting bowel; laparotomyBowel obstructionHistory: abdominal pain, distention, vomiting, constipation
Exam: tenderness, abdominal guarding, distension (acute episode)
Obtain KUB in patients with clinical symptoms of obstruction
Surgical consultation in patients unresponsive to medical management
Pelvic surgery; cystectomyFecal incontinenceHistory: chronic constipation, fecal soiling
Rectal exam