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IntroductionWorldwide 1,470,900 women are diagnosed yearly with a gynaecological malignancy; 21 000 in the UK. Some patients treated with pelvic radiotherapy develop chronic changes in their bowel function. Current research on the impact of treatment on the gut and vaginal microbiome in women with a gynaecological malignancy is reviewed.MethodThe PRISMA guidelines for systematic reviews were used to ensure transparent and complete reporting. The protocol was registered on the International PROSPERO database. Quantitative studies exploring the gut or vaginal microbiome in this patient cohort were included. Animal studies were excluded. There were no language restrictions.ResultsThree prospective cohort studies were identified using sequencing of changes in the gut microbiome reporting on 23 women treated for gynaecological cancer1-3. All studies included patients treated with radiotherapy with a dosage ranging from 43.0 to 54.0 Gy. 8 women (57%) developed grade 2 or 3 diarrhoea1,3. A correlation between changes in the intestinal microbiome and receiving radiotherapy is suggested with a decrease in abundance and diversity of the intestinal bacterial species1-3. Prior to radiotherapy, those with diarrhoea had increased abundance of Bacteroides, Dialister, Veillonella (p<0.01), and decreased abundance of Clostridium, Faecalibacterium, Oscillibacter, Parabacteroides, Prevotella (p<0.05)3.[Figure]ConclusionThe limited evidence to date implies that larger studies including both the vaginal and gut microbiome in women treated for a gynaecological malignancy are warranted to explore the impact of cancer treatments on the microbiome and its relation to developing long-term GI toxicity. This may lead to new avenues to stratify those at risk and explore personalised treatment options and prevention of gastrointestinal consequences of cancer treatments.References. Manichanh C, Varela E, Martinez C, et al. The gut microbiome predispose to the pathophysiology of acute postradiotherapy diarrhoea. Am J Gastroenterol2008;103:1754–61.. Nam Y, Kim H, Seo J et al. Impact of pelvic radiotherapy on gut microbiome of gynaecological cancer patients revealed by massive pyrosequencing. PLoS ONE2013;8:e82659.. Wang A, Ling Z, Yang Z et al. Gut Microbial Dysbiosis May Predict Diarrhoea and Fatigue in Patients Undergoing Pelvic Cancer Radiotherapy: A Pilot Study. PLoS ONE2015;10(5):e0126312.Disclosure of InterestNone Declared

IntroductionDietary fat ingestion triggers bile secretion into the gastrointestinal (GI) tract. Bile acid diarrhoea (BAD) or malabsorption (BAM) affects 1%–2% of the population. Affected individuals suffer a wide range of GI symptoms in addition to loose stool. The diagnosis is often missed and treatments are often reported to be ineffective. In this study we used SEHCAT scanning to determine treatment options and evaluated the impact of low-fat diets on GI symptoms in these patients.MethodThis study analysed prospectively collected data in patients with 7 day 75selenium homocholic acid taurine (SeHCAT) scan retention <20%. All patients reporting type 6 or 7 stool were offered a SeHCAT scan. Patients with abnormal scans requiring a bile acid sequestrant were given this before receiving dietary advice. Patients completed a 7 day food diary before consultation with a registered dietitian and personalised low-fat dietary interventions, providing 20% of daily energy from fat were prescribed. Symptoms were assessed using a modified Gastrointestinal Symptom Rating Scale questionnaire before and 4–12 weeks after dietary intervention.ResultsBetween January 2014 to March 2016, 114 patients, 49 men and 65 women, median age of 64 years, median BMI of 27 kg/m2were evaluated. 50% had previously undergone GI surgery and 45% had additional GI disorders. 44% were taking Colesevelam. After dietary intervention, the frequency with which patients experienced GI symptoms decreased, with a significant reduction in troublesome urgency, flatulence, abdominal pain, nocturnal defaecation, belching and borborygmi (p≤0.01). Stool consistency and stool frequency also improved.ConclusionDietary intervention is an effective treatment option for patients with symptomatic bile acid malabsorption/diarrhoea and should be routinely considered. The exact fat restriction which is effective, requires further study.Disclosure of InterestNone Declared