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Colorectal Cancer Treatments and Studies / Colorectal and Anal Carcinomas · Journal article
The Turkish Journal of Gastroenterology · August 11, 2026
A consensus or society position rather than new primary data.
This is a narrative review summarizing current evidence on the pathogenesis, clinical presentation, diagnosis, and management of gastrointestinal immune-related adverse events associated with immune checkpoint inhibitors. The authors emphasize that management is largely guided by expert consensus and requires multidisciplinary collaboration, with early recognition and appropriate grading critical to optimize outcomes.
Journal article. Patients receiving immune checkpoint inhibitors across multiple malignancies who experience gastrointestinal immune-related adverse events..
Lower GI toxicity, particularly diarrhea and colitis, is more common and clinically significant than upper GI involvement, especially in patients receiving anti-CTLA-4–based and combination regimens. Upper GI involvement (esophagitis, gastritis, duodenitis) is relatively uncommon and typically presents with nonspecific symptoms and heterogeneous endoscopic findings despite macroscopically normal-appearing mucosa. Endoscopic evaluation with mucosal biopsy remains central to diagnosis because clinical severity does not always correlate with endoscopic or histopathologic activity.
Lower GI toxicity, particularly diarrhea and colitis, is more common and clinically significant than upper GI involvement, especially in patients receiving anti-CTLA-4–based and combination regimens.
Clinicians should recognize that GI irAEs require endoscopic evaluation with biopsy for accurate diagnosis and grading, as clinical severity does not reliably predict histopathologic findings. Early multidisciplinary collaboration between oncologists and gastroenterologists is essential to manage these toxicities while preserving cancer immunotherapy benefits.
This is a narrative review synthesizing current evidence on ICI-related GI toxicity pathogenesis, diagnosis, and management, guided by expert consensus rather than new primary data.
Clinicians should recognize that GI irAEs require endoscopic evaluation with biopsy for accurate diagnosis and grading, as clinical severity does not reliably predict histopathologic findings. Early multidisciplinary collaboration between oncologists and gastroenterologists is essential to manage these toxicities while preserving cancer immunotherapy benefits.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape across multiple malignancies. However, their expanding use has been accompanied by an increasing spectrum of immune-related adverse events (irAEs), particularly those affecting the gastrointestinal (GI) tract. GI toxicities may involve both the upper and lower GI tract and range from mild, nonspecific symptoms to severe inflammatory complications requiring treatment interruption, hospitalization, or selective immunosuppressive therapy. This review summarizes the current evidence regarding the pathogenesis, clinical presentation, endoscopic and histopathologic findings, and management of GI irAEs associated with ICIs. Upper GI involvement, including esophagitis, gastritis, and duodenitis, is relatively uncommon and typically presents with nonspecific symptoms and heterogeneous endoscopic findings, which may occur despite a macroscopically normal-appearing mucosa. Lower GI toxicity, particularly diarrhea and colitis, is more common and clinically significant, especially in patients receiving anti-CTLA-4–based and combination regimens. Endoscopic evaluation with mucosal biopsy remains central to diagnosis because clinical severity does not always correlate with endoscopic or histopathologic activity. Histopathologic patterns are heterogeneous and may overlap with those of other inflammatory or infectious GI disorders, making clinicopathologic correlation essential. Current management is largely guided by expert consensus and includes supportive care, corticosteroids, and biologic rescue therapy with agents such as infliximab or vedolizumab for steroid-refractory disease. Early recognition, appropriate grading, exclusion of alternative etiologies, and multidisciplinary collaboration among oncologists and gastroenterologists are critical to optimize outcomes while preserving the benefits of cancer immunotherapy. Cite this article as: Cankurtaran RE, Karpuzcu HC, Yurekli OT. Immune checkpoint inhibitor–related gastrointestinal toxicity: Pathogenesis, diagnosis, and management. Turk J Gastroenterol. Published online August 11, 2026. doi: 10.5152/tjg.2026.26304.
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