Radiation enteritis (RE) is an iatrogenic ailment that involves injury to the small intestine, resulting from radiation therapy employed in the treatment of malignancies. RE affects the majority of patients undergoing radiation in the abdomen or pelvis [1]. Factors that predispose patients to RE entail high dose radiotherapy, cardiovascular disease, and those simultaneously receiving chemotherapy.

RE may be acute or chronic in nature. Acute disease may present with abdominal pain, in addition to a variety of nonspecific gastrointestinal (GI) symptoms such as nausea, vomiting, anorexia, and change in bowel habits. These occur and peak with 2 to 5 weeks of initiation of therapy [2]. Acute RE often resolves spontaneously, after 3 months of treatment [3].

Chronic RE has a much slower onset and may transpire years after exposure to radiotherapy [4]. It occurs due to repeated injury of the gut, leading to inflammation and atrophy of mucosal cells, fibrosis, and impaired healing [5]. The nature and severity of symptoms correspond with the associated damage [6]. Furthermore, radiotherapy affects local blood vessels, causing arterial occlusion by surrounding tissues, that is, endarteritis obliterans, leading to chronic ischemia. Chronic RE manifests as nonspecific GI symptoms, bowel obstruction, fat malabsorption and abdominal pain associated with food intake [7]. Micronutrient deficiencies, such as vitamin B12 and calcium, are also known findings.

• Sepsis

  Home parenteral nutrition was prescribed due to poor oral intake, but it was discontinued after 6 catheter-related sepsis and upper cava vein thrombosis. [ncbi.nlm.nih.gov]

  Sepsis and raised inflammatory markers may be observed if there is an intestinal obstruction. There may also be a concurrent electrolyte imbalance, abnormal liver function tests, and coagulopathy. [symptoma.com]

  Perforation should be treated with resection of the involved segment, because bypass inevitably leads to the complications of fistula, peritonitis, or sepsis. [emedicine.medscape.com]

• Anorexia

  Acute disease may present with abdominal pain, in addition to a variety of nonspecific gastrointestinal (GI) symptoms such as nausea, vomiting, anorexia, and change in bowel habits. These occur and peak with 2 to 5 weeks of initiation of therapy. [symptoma.com]

  Definition / general Observed acutely or years after radiation therapy for cervical carcinoma, Wilms tumor, lymphoma or other peritoneal tumors Clinical features Acute: anorexia, cramps, diarrhea due to mucosal injury and malabsorption Chronic: may present [pathologyoutlines.com]

  Radiation Enteritis include: Changes in bowel movements that include: Bleeding from the rectum Diarrhea or watery stools Constant feeling of a need for bowel movement Pain in the rectal area, especially during bowel movement Nausea Vomiting, diarrhea Anorexia [dovemed.com]

• Aspiration

  Glucose hydrogen/methane breath testing ± duodenal (D2) aspirate via upper GI endoscopy. [doi.org]

  With older patients, aspiration potential suggests that mineral oil be avoided because it can cause lipid pneumonitis. It can interfere with postoperative healing of anorectal surgery. Avoid giving with docusate sodium. [cancer.gov]

• Diarrhea

  During irradiation, diarrhea occurred in 69% and 66% of the 5-ASA and placebo groups, respectively (chi2, P = 0.22). Curves of survival without diarrhea did not differ between groups (logrank P = 0.09). [ncbi.nlm.nih.gov]

  NOS ( R19.7 ) functional diarrhea ( K59.1 ) infectious gastroenteritis and colitis NOS ( A09 ) neonatal diarrhea (noninfective) ( P78.3 ) psychogenic diarrhea ( F45.8 ) due to radiation K52.0 Enteritis (acute) (diarrheal) (hemorrhagic) (noninfective) [icd10data.com]

  Spicy foods trigger diarrhea for many. (Image: Philhillphotography/iStock/Getty Images) Each individual has different types of foods that trigger diarrhea, and for many the offending source is spicy foods. [livestrong.com]

  When the abdomen receives radiation, there is always some nausea, vomiting, and diarrhea. In most cases, the symptoms get better within 2 to 3 months after treatment ends. [medlineplus.gov]

• Constipation

  Constipation was more common in the placebo arm but this did not reach significance (P = 0.20). 5-ASA thus has no protective effect against acute radiation enteritis and appears to worsen it. [ncbi.nlm.nih.gov]

  Chronic use of drugs for constipation.[ 1 ] Laxatives used to decrease constipation are the drugs that contribute most to the development of constipation and impaction. [cancer.gov]

  […] and abdominal pain and may require help from a dietitian. 12–14 Biofeedback Biofeedback is widely regarded as a useful, non-invasive treatment in constipation, evacuatory disorders and faecal incontinence. [doi.org]

  […] disease (1068) Ulcerative colitis (1177) Liver disease Alcoholic liver disease (134) Cirrhosis (383) Hepatitis B (107) Hepatitis C (172) Hepatitis other (169) Nonalcoholic steatosis (158) Neurogastroenterology Chronic intestinal pseudo-obstruction (34) Constipation [gut.bmj.com]

• Chronic Diarrhea

  Answer: Chronic radiation enteritis is the technical term for the long-term damage that can result after radiation therapy for rectal cancer. It can lead to chronic diarrhea, incontinence, and bowel urgency. [oncologynutrition.org]

  Counseling from a Registered Dietitian and adherence to a strict gluten-free diet completely eliminated the chronic diarrhea. 24) Some RDs are reporting that a few patients have had successful resolution of long-standing diarrhea by the use of either [cancerrd.com]

• Periodontitis

  Trigger events can be tooth extractions, other surgery or injury in the jaw area, ill-fitting dentures, periodontal disease and other oral inflammation, taking medications which reduce blood circulation, too much alcohol, smoking etc. [healingcancernaturally.com]

• Osteoporosis

  Case 6: chemotherapy can cause osteoporosis See testimonial. [healingcancernaturally.com]

• Excitement

  I was excited thinking I could have that section removed and go on to be normal again, but the surgeon I visited twice was very discouraging, he said we could do a laproscopic exploratory surgery but he may or may not find any one section he can remove [cancercompass.com]

  This study provides novel and exciting evidence of the effect of circadian rhythm on intestinal mucosa. The panel was encouraged by these findings and look forward to more evidence in future years. [doi.org]

RE is a significant problem, as it negatively impacts the quality of life. Furthermore, the condition may not receive adequate attention and treatment due to patients being less forthcoming about GI complaints, as well as clinicians failing to recognize and refer the former to specialists [1] [8]. It is thus important to educate patients about the possible gastrointestinal side effects of radiotherapy and encourage a preventative health-seeking behavior. In radiation enteritis, the medical history is of significant importance, as it may reveal radiotherapy exposure, possibly many years prior to presentation. Clinical examination further aids in diagnosis.

Biochemically, chronic RE may be evidenced by anemia and malnutrition [9]. Sepsis and raised inflammatory markers may be observed if there is an intestinal obstruction. There may also be a concurrent electrolyte imbalance, abnormal liver function tests, and coagulopathy.

Radiological techniques are useful, as there are a number of changes that are detectable. Computed tomography (CT) and magnetic resonance imaging (MRI) scans may show signs of intestinal wall inflammation such as thickening of the bowel walls, edema, and features of intestinal obstruction. Fistula formation, between the bowel and adjacent pelvic structures, may also be visualized in this way. The small bowel, as inspected via fluoroscopic enteroclysis, may exhibit signs of edema and fibrosis, stenosis and ulcers. There may be segments that appear similar to a stack of coins. Other radiological exams carried out include barium studies. Invasive techniques include endoscopy.

Several gastrointestinal disorders may be considered as differential diagnoses, such as Crohn's disease, malignant metastases, ischemia and enteritis due to alternative agents.

Acute RE often resolves spontaneously, after 3 months of treatment. Chronic RE has a much slower onset and may transpire years after exposure to radiotherapy. [symptoma.com]

Abstract Acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. [ncbi.nlm.nih.gov]

Cox survival analysis taking into account the stage of the cancer and the age at diagnosis showed that rectal bleeding is a factor with a prognosis significantly poorer than the mild symptoms (p = 0.05), equivalent to that of the severe complications. [ncbi.nlm.nih.gov]

What is the Prognosis of Radiation Enteritis? (Outcomes/Resolutions) The prognosis for Radiation Enteritis is very good when the symptoms are acute. [dovemed.com]

Outlook (Prognosis) When the abdomen receives radiation, there is always some nausea, vomiting, and diarrhea. In most cases, the symptoms get better within 2 - 3 months after treatment ends. [nicklauschildrens.org]

We reviewed the etiology, prevalence, symptoms, diagnosis and management of CRE and CRE with malnutrition in this article. Functional short bowel syndrome as a cause of malnutrition in CRE is also considered. [ncbi.nlm.nih.gov]

Etiology and Pathophysiology Radiation injury activates intracellular mechanisms which alter cell division, leading to inflammation or cell death. Injury likely mediated indirectly by free-radical release, affecting DNA repair. [unboundmedicine.com]

(Etiology) Radiation therapy is commonly used to treat cancer and it employs the use of high-energy particles or waves, such as x-rays, gamma rays, electron or proton beams, to destroy cancer cells by damaging their DNA Intestinal lining cells, which [dovemed.com]

CMCR and oncology clinical trial group leaders were joined by experts in epidemiology and quality of life issues, representatives from the pharmaceutical industry, patient advocates, and U.S. Food and Drug Administration (FDA) officials. [doi.org]

A hypodeiodination condition and a potential pituitary-thyrotroph dysfunction might play a role in the pathophysiology of LT3S in RE. Worse nutritional status and clinical outcomes were confirmed in RE patients with LT3S. [ncbi.nlm.nih.gov]

Etiology and Pathophysiology Radiation injury activates intracellular mechanisms which alter cell division, leading to inflammation or cell death. Injury likely mediated indirectly by free-radical release, affecting DNA repair. [unboundmedicine.com]

Pathophysiology Ionising radiation generates free radicals from intracellular water, which in turn affect DNA synthesis. Cells with a high proliferation rate tend to be more susceptible to radiation injury. [surgwiki.com]

Ann Gastroenterol Hepatol (Paris) 24:7–12 CAS Google Scholar Marx RE (1983) Osteoradionecrosis: a new concept of its pathophysiology. [link.springer.com]

Clinical, pathophysiologic and radiobiologic aspects. A review. Acta Oncol. 1990;29(4):401-415. http://doi.org/10.3109/02841869009090022 Rogler G, Gelbmann CM, Vogl D, Brunner M, Schölmerich J, Falk W, Andus T, Brand K. [revistagastrocol.com]

An increased understanding of the tissue response and the clinical features of radiation enteritis has led to advances in the prevention and management of this condition. [ncbi.nlm.nih.gov]

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