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Risk of thiamine deficiency and Wernicke’s encephalopathy after gastrointestinal surgery for cancer

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Abstract

Background

Cancer patients submitted to gastrointestinal surgery are at risk of thiamine deficiency (TD) and Wernicke’s encephalopathy (WE). Although permanent neurological damage and death could be prevented by a timely replacement therapy, they often remain undiagnosed and untreated. We hypothesized that WE remains unrecognized because most cases may manifest several months after hospital discharge.

Methods

WE frequency was investigated in a sample of cancer patients who underwent gastrointestinal surgery, by using the diagnostic criteria proposed to improve diagnosis among alcoholics. Patients were evaluated at discharge through the examination of medical records and 6 months after by telephonic interview.

Results

Forty-five patients were selected. Signs of WE resulted in 4.4 % at discharge. At 6 months, 21 patients were interviewed. Among them, 90.4 % had signs of WE. The number of affected patients was significantly higher 6 months after discharge than at discharge (90.4 vs 9.5 %, p < 0.0001).

Conclusions

Further studies with larger samples are needed to establish the prevalence of TD and related WE in cancer patients after gastrointestinal surgery. This study suggests that the problem is understated. Even in absence of symptoms of TD, the use of prophylactic thiamine supplementation should be taken in consideration, as consequences of misdiagnosis can be severe.

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References

  1. Thomson AD, Cook CC, Guerrini I, Sheedy D, Harper C, Marshall EJ (2008) Wernicke’s encephalopathy revisited. Translation of the case history section of the original manuscript by Carl Wernicke ‘Lehrbuch der Gehirnkrankheiten fur Aerzte and Studirende’ (1881) with a commentary. Alcohol Alcohol 43(2):174–179. doi:10.1093/alcalc/agm144

    Article  PubMed  Google Scholar 

  2. Sechi G, Serra A (2007) Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 6(5):442–455. doi:10.1016/S1474-4422(07)70104-7

    Article  CAS  PubMed  Google Scholar 

  3. Lough ME (2012) Wernicke’s encephalopathy: expanding the diagnostic toolbox. Neuropsychol Rev 22(2):181–194. doi:10.1007/s11065-012-9200-7

    Article  PubMed  Google Scholar 

  4. Donnino MW, Vega J, Miller J, Walsh M (2007) Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know. Ann Emerg Med 50(6):715–721. doi:10.1016/j.annemergmed.2007.02.007

    Article  PubMed  Google Scholar 

  5. Galvin R, Brathen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 17(12):1408–1418. doi:10.1111/j.1468-1331.2010.03153.x

    Article  CAS  PubMed  Google Scholar 

  6. Kuo SH, Debnam JM, Fuller GN, de Groot J (2009) Wernicke’s encephalopathy: an underrecognized and reversible cause of confusional state in cancer patients. Oncology 76(1):10–18. doi:10.1159/000174951

    Article  PubMed  Google Scholar 

  7. Ogershok PR, Rahman A, Nestor S, Brick J (2002) Wernicke encephalopathy in nonalcoholic patients. Am J Med Sci 323(2):107–111

    Article  PubMed  Google Scholar 

  8. Thomson AD, Marshall EJ (2006) The natural history and pathophysiology of Wernicke’s encephalopathy and Korsakoff’s psychosis. Alcohol Alcohol 41(2):151–158. doi:10.1093/alcalc/agh249

    Article  CAS  PubMed  Google Scholar 

  9. Rufa A, Rosini F, Cerase A, Giannini F, Pretegiani E, Buccoliero R, Dotti MT, Federico A (2011) Wernicke encephalopathy after gastrointestinal surgery for cancer: causes of diagnostic failure or delay. Int J Neurosci 121(4):201–208. doi:10.3109/00207454.2010.544430

    Article  CAS  PubMed  Google Scholar 

  10. Aasheim ET (2008) Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg 248(5):714–720. doi:10.1097/SLA.0b013e3181884308

    PubMed  Google Scholar 

  11. Karayiannakis AJ, Souftas VD, Bolanaki H, Prassopoulos P, Simopoulos C (2011) Wernicke encephalopathy after pancreaticoduodenectomy for pancreatic cancer. Pancreas 40(7):1157–1159. doi:10.1097/MPA.0b013e31822182f5

    Article  PubMed  Google Scholar 

  12. Shimomura T, Mori E, Hirono N, Imamura T, Yamashita H (1998) Development of Wernicke-Korsakoff syndrome after long intervals following gastrectomy. Arch Neurol 55(9):1242–1245

    Article  CAS  PubMed  Google Scholar 

  13. Spinazzi M, Angelini C, Patrini C (2010) Subacute sensory ataxia and optic neuropathy with thiamine deficiency. Nat Rev Neurol 6(5):288–293. doi:10.1038/nrneurol.2010.16

    Article  PubMed  Google Scholar 

  14. Caine D, Halliday GM, Kril JJ, Harper CG (1997) Operational criteria for the classification of chronic alcoholics: identification of Wernicke’s encephalopathy. J Neurol Neurosurg Psychiatry 62(1):51–60

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Pitel AL, Zahr NM, Jackson K, Sassoon SA, Rosenbloom MJ, Pfefferbaum A, Sullivan EV (2011) Signs of preclinical Wernicke’s encephalopathy and thiamine levels as predictors of neuropsychological deficits in alcoholism without Korsakoff’s syndrome. Neuropsychopharmacology 36(3):580–588. doi:10.1038/npp.2010.189

    Article  PubMed Central  PubMed  Google Scholar 

  16. Gregory J, Philbrick K, Chopra A (2012) Wernicke encephalopathy in a non-alcoholic patient with metastatic CNS lymphoma and new-onset occipital lobe seizures. J Neuropsychiatry Clin Neurosci 24(4), E53. doi:10.1176/appi.neuropsych.11110344

    Article  PubMed  Google Scholar 

  17. Kim KH (2014) Wernicke-Korsakoff syndrome in primary peritoneal cancer. Case Rep Oncol 6(3):593–597. doi:10.1159/000357519

    Google Scholar 

  18. D’Abbicco D, Praino S, Amoruso M, Notarnicola A, Margari A (2012) “Syndrome in syndrome”: Wernicke syndrome due to afferent loop syndrome. Case report and review of the literature. G Chir 32(11–12):479–482

    Google Scholar 

  19. Nolli M, Barbieri A, Pinna C, Pasetto A, Nicosia F (2005) Wernicke’s encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imaging. Acta Anaesthesiol Scand 49(10):1566–1570. doi:10.1111/j.1399-6576.2005.00879.x

    Article  CAS  PubMed  Google Scholar 

  20. Onishi H, Kawanishi C, Onose M, Yamada T, Saito H, Yoshida A, Noda K (2004) Successful treatment of Wernicke encephalopathy in terminally ill cancer patients: report of 3 cases and review of the literature. Support Care Cancer 12(8):604–608. doi:10.1007/s00520-004-0637-y

    Article  PubMed  Google Scholar 

  21. Papila B, Yildiz O, Tural D, Delil S, Hasiloglu ZI, Ayan F, Papila C (2010) Wernicke’s encephalopathy in colon cancer. Case Rep Oncol 3(3):362–367. doi:10.1159/000321457

    Article  PubMed Central  PubMed  Google Scholar 

  22. Schattner A, Kedar A (2013) An unlikely culprit—the many guises of thiamine deficiency. Am J Emerg Med 31(3):e635–e636. doi:10.1016/j.ajem.2012.10.024

    Article  Google Scholar 

  23. Attard O, Dietemann JL, Diemunsch P, Pottecher T, Meyer A, Calon BL (2006) Wernicke encephalopathy: a complication of parenteral nutrition diagnosed by magnetic resonance imaging. Anesthesiology 105(4):847–848

    Article  PubMed  Google Scholar 

  24. Kitamura K, Takahashi T, Tanaka H, Shimotsuma M, Hagiwara A, Yamaguchi T, Hashimoto S (1993) Two cases of thiamine deficiency-induced lactic acidosis during total parenteral nutrition. Tohoku J Exp Med 171(2):129–133

    Article  CAS  PubMed  Google Scholar 

  25. Messina G (1956) Changes in nerve excitability & conductibility induced by novocaine combined with thiamine. Boll Soc Ital Biol Sper 32(10–11):1360–1362

    CAS  PubMed  Google Scholar 

  26. Perko R, Harreld JH, Helton KJ, Sabin ND, Haidar CE, Wright KD (2012) What goes around comes around? Wernicke encephalopathy and the nationwide shortage of intravenous multivitamins revisited. J Clin Oncol 30(31):e318–e320. doi:10.1200/JCO.2012.42.7237

    Article  PubMed Central  PubMed  Google Scholar 

  27. Sriram K, Manzanares W, Joseph K (2012) Thiamine in nutrition therapy. Nutr Clin Pract 27(1):41–50. doi:10.1177/0884533611426149

    Article  PubMed  Google Scholar 

  28. Manzanares W, Hardy G (2011) Thiamine supplementation in the critically ill. Curr Opin Clin Nutr Metab Care 14(6):610–617. doi:10.1097/MCO.0b013e32834b8911

    Article  CAS  PubMed  Google Scholar 

  29. Hazell AS (2009) Astrocytes are a major target in thiamine deficiency and Wernicke’s encephalopathy. Neurochem Int 55(1–3):129–135. doi:10.1016/j.neuint.2009.02.020

    Article  CAS  PubMed  Google Scholar 

  30. Hazell AS, Butterworth RF (2009) Update of cell damage mechanisms in thiamine deficiency: focus on oxidative stress, excitotoxicity and inflammation. Alcohol Alcohol 44(2):141–147. doi:10.1093/alcalc/agn120

    Article  CAS  PubMed  Google Scholar 

  31. Agabio R (2005) Thiamine administration in alcohol-dependent patients. Alcohol Alcohol 40(2):155–156. doi:10.1093/alcalc/agh106

    Article  CAS  PubMed  Google Scholar 

  32. Isenberg-Grzeda E, Hsu AJ, Hatzoglou V, Nelso C, Breitbart W (2014) Palliative treatment of thiamine-related encephalopathy (Wernicke’s encephalopathy) in cancer: a case series and review of the literature. Palliat Support Care. doi:10.1017/S1478951514001163, 1–9

    PubMed  Google Scholar 

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Acknowledgments

The authors gratefully acknowledge the Sardinia Regional Government for the financial support (P.O.R. Sardegna F.S.E. Operational Programme of the Autonomous Region of Sardinia, European Social Fund 2007–2013 - Axis IV Human Resources, Objective l.3, Line of Activity l.3.1 “Avviso di chiamata per il finanziamento di Assegni di Ricerca”.

Fundings and support

Angelo Restivo receives financial support for his activity from regional government.

Conflict of interest

There is no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Surgery, Colorectal Surgery Center, University of Cagliari, Policlinico Universitario, 09100, Cagliari, Italy

    Angelo Restivo

  2. Unit of Psychosomatics and Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy

    Mauro Giovanni Carta

  3. Clinical Nutrition Center, Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy

    Anna Maria Giulia Farci & Laura Saiu

  4. Neuroscience Institute, National Research Council of Italy, Section of Cagliari, Cagliari, Italy

    Gian Luigi Gessa

  5. Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy

    Gian Luigi Gessa & Roberta Agabio

Authors
  1. Angelo Restivo
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  2. Mauro Giovanni Carta
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  3. Anna Maria Giulia Farci
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  4. Laura Saiu
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  5. Gian Luigi Gessa
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  6. Roberta Agabio
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Corresponding author

Correspondence to Angelo Restivo.

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Synopsis

Frequencies of thiamin deficiency and related Wernicke’s encephalopathy were investigated in cancer patients submitted to gastrointestinal surgery. Signs and/or symptoms of encephalopathy were frequent (93 % of cases) at 6 months after surgery. Use of prophylactic thiamin should be investigated.

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Restivo, A., Carta, M.G., Farci, A.M.G. et al. Risk of thiamine deficiency and Wernicke’s encephalopathy after gastrointestinal surgery for cancer. Support Care Cancer 24, 77–82 (2016). https://doi.org/10.1007/s00520-015-2748-z

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  • DOI: https://doi.org/10.1007/s00520-015-2748-z

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