Radiation esophagitis is by many authors divided into two forms - acute and chronic [1] [2] [3] [4]. Acute radiation esophagitis is defined as the onset of esophageal-related symptoms as a response to radiation therapy (RT) within 3 weeks [1] [2] [3] [4]. Most commonly reported complaints are nausea, odynophagia, dysphagia, and anorexia that can promote significant weight loss [1] [2] [4]. Pain in the substernal region and discomfort is also seen in many patients, developing on the grounds of inflammatory changes occurring in the esophageal mucosa [1] [2]. The severity of the associated features strongly correlates with the radiation dose (more pronounced signs are seen with higher doses), a more advanced tumor stage, increased age, and the presence of adjuvant chemotherapy (bleomycin, vincristine, cyclophosphamide, actinomycin, and daunorubicin) [1] [2] [3] [5]. Some patients may not be able to swallow any food and thus require a feeding tube and/or total parenteral nutrition [2]. On the other hand, chronic radiation esophagitis occurs when at least three months pass from RT to the onset of the signs of the ailment, but the majority of patients report around 6-12 months [1] [2] [4]. The formation of esophageal strictures from fibrotic changes is the main factor for the development of symptoms in these patients, most important being progressive dysphagia, associated swallowing difficulties, and impaired mobility of the esophagus [1] [2].

• Pain

  ] Esophagitis-related pain was measured using patient-reported pain on swallowing as assessed by the Numerical Rating Pain Scale (NRPS), an 11-point scale (0-10) in which 0 indicates no pain and 10 indicates the worst pain imaginable. [clinicaltrials.gov]

  […] indicating "worst possible pain." [sciencedaily.com]

  […] indicating “worst possible pain.” [astro.org]

  My mom is being fed through a g tube in her stomach because she can't swallow without a great deal of pain. She's been on all the pain meds, syrups and numbing agents. [inspire.com]

  Patients kept a pain diary that helped determine swallowing pain as assessed on an 11-point scale at four weeks of radiation therapy—the primary endpoint of the study. [journals.lww.com]

• Weight Loss

  Most commonly reported complaints are nausea, odynophagia, dysphagia, and anorexia that can promote significant weight loss. [symptoma.com]

  Additionally, researchers evaluated secondary endpoints, such as the trend of the patients' pain over time, opiod use, adverse events, weight loss, quality of life, dysphagia and nutritional status. [sciencedaily.com]

  Needless to say, this can cause functional impairment, and severe chemoradiation-induced esophageal toxicity can lead to malnutrition, dehydration, and weight loss, all of which can put patients in a position for intravenous treatment or hospitalization [medpagetoday.com]

  Additionally, researchers evaluated secondary endpoints, such as the trend of the patients’ pain over time, opiod use, adverse events, weight loss, quality of life, dysphagia and nutritional status. [astro.org]

  Patients with dysphagia, odynophagia, weight loss, and/or anemia should undergo endoscopy in a facilitated manner because of a higher risk of malignancy. Video Endoscopic Sequence 3 of 4. [gastrointestinalatlas.com]

• Candidiasis

  Patients who are on steroid treatments or have a suppressed immune system from their cancer treatments may develop an esophagitis caused by a fungal infection (esophageal candidiasis). [oncolink.org]

  The physical examination should focus on excluding oral candidiasis (through inspection of the oral cavity), recurrence of the primary disease (by palpating proximal lymph nodes) and aspiration pneumonia (through lung auscultation). [symptoma.com]

  Esophageal candidiasis. Managing an increasingly prevalent infection. Postgrad Med. 1988 Aug. 84(2):193-6, 201-5. [Medline]. Kliemann DA, Pasqualotto AC, Falavigna M, Giaretta T, Severo LC. [emedicine.medscape.com]

  Types include: Fungal Candida ( Esophageal candidiasis ) Viral Herpes simplex ( Herpes esophagitis ) Cytomegalovirus Drug-induced esophagitis Damage to the esophagus due to medications. [en.wikipedia.org]

  Radiation oral mucositis can often coexist with oropharyngeal candidiasis, and both should be sought out and treated. B. [clinicaladvisor.com]

• Anorexia

  Most commonly reported complaints are nausea, odynophagia, dysphagia, and anorexia that can promote significant weight loss. [symptoma.com]

  This can be associated with crampy abdominal pain, malaise, nausea, and anorexia. It should subside within 2-6 weeks following cessation of radiation therapy, with a large majority resolved to minimal side effects within 2 weeks. [clinicaladvisor.com]

  Symptoms: diarrhea, abdominal cramping, and nausea Chronic Radiation Enteritis - symptoms don't occur for 6 months to 25 years after treatment and usually require more serious treatment Other symptoms may include dry mouth, anorexia, and stomatitis (inflammation [physio-pedia.com]

  The meta‐analysis of incidence of pneumonitis was RR 0.62 (95% CI 0.23 to 1.66; low quality of evidence) Figure 5 Tiredness MRC 1996 also showed that the higher dose (13 fraction) regimen caused more tiredness and anorexia than the 2 fraction regimen. [cochranelibrary.com]

• Malaise

  This can be associated with crampy abdominal pain, malaise, nausea, and anorexia. It should subside within 2-6 weeks following cessation of radiation therapy, with a large majority resolved to minimal side effects within 2 weeks. [clinicaladvisor.com]

• Aspiration

  Elsevier Health Sciences, ١٨‏/٠٩‏/٢٠٠٨ - 1136 من الصفحات This best-selling book provides you with a comprehensive guide to the diagnostic applications of exfoliative and aspiration cytology. [books.google.com]

  The physical examination should focus on excluding oral candidiasis (through inspection of the oral cavity), recurrence of the primary disease (by palpating proximal lymph nodes) and aspiration pneumonia (through lung auscultation). [symptoma.com]

  This mixture can suppress a persons gag reflex; therefore patients should eat slowly and sit upright for at least 30 minutes after eating to prevent aspiration. Appropriate antibiotic or anti- fungal for infection. [oncolink.org]

  Aspiration significant concern Esophageal phase: peristaltic movement to propel food into stomach. [en.wikibooks.org]

  If eso stasis because of achalasia, diverticula, or tight strictures, may require a prolonged fast or NGT to minimize aspiration. [slideplayer.com]

• Pneumonia

  The physical examination should focus on excluding oral candidiasis (through inspection of the oral cavity), recurrence of the primary disease (by palpating proximal lymph nodes) and aspiration pneumonia (through lung auscultation). [symptoma.com]

  Pneumocystis carinii pneumonia, community-acquired pneumonia, drug-induced pneumonitis, metastatic disease to the lungs or lymphangitic carcinomatosis should also be considered. [clinicaladvisor.com]

  Localizare stenoza Protezare esofag proximal  Compresia traheala  Complicatii:  Perforatie  Formare fistule  Pneumonia de aspiratie  Toleranta pacient (senzatie globus) 23. [slideshare.net]

  Primary Candida pneumonia. Experience at a large cancer center and review of the literature. Medicine (Baltimore). 1993 May. 72(3):137-42. [Medline]. Levine MS, Macones AJ Jr, Laufer I. Candida esophagitis: accuracy of radiographic diagnosis. [emedicine.medscape.com]

  The reason for this belief is that placing stents at this location was thought to be associated with a high risk of complications, such as perforation, aspiration pneumonia, proximal migration, and patient intolerance caused by pain and foreign body sensation [nature.com]

• Dysphagia

  Most commonly reported complaints are nausea, odynophagia, dysphagia, and anorexia that can promote significant weight loss. [symptoma.com]

  Moderate dysphagia was still present, allowing nearly normal oral feeding.(ABSTRACT TRUNCATED AT 250 WORDS). [ncbi.nlm.nih.gov]

  Guideline: The role of endoscopy in the evaluation& management of dysphagia. GIE; 79, No 2 : 2014 Prepared by: Dr.Mohamed Al-Shekhani. 2 Causes of esophageal dysphagia: Dysphagia result from structural or motor disorders. [slideplayer.com]

• Odynophagia

  Most commonly reported complaints are nausea, odynophagia, dysphagia, and anorexia that can promote significant weight loss. [symptoma.com]

  Patients typically present with nonspecific symptoms such as dysphagia and odynophagia. Endoscopic changes such as erythema and ulceration are also nonspecific and nondiagnostic. [ncbi.nlm.nih.gov]

  Topical anesthetics or NSAIDs, Soft diet Moderate dysphagia or odynophagia, Narcotic analgesics, Puree or liquid diet Severe dysphagia or odynophagia, Dehydration or weigh loss >15%, IV fluids, NGT, TPN Complete obstruction, ulceration, perforation, [en.wikibooks.org]

  Patients with dysphagia, odynophagia, weight loss, and/or anemia should undergo endoscopy in a facilitated manner because of a higher risk of malignancy. Video Endoscopic Sequence 3 of 4. [gastrointestinalatlas.com]

• Nausea

  Most commonly reported complaints are nausea, odynophagia, dysphagia, and anorexia that can promote significant weight loss. [symptoma.com]

  […] mucositis Radiation injury of bone Radiation injury of bone marrow Radiation nephritis Radiation proctitis Radiation recall reaction due to cytotoxic therapy Radiation recall syndrome Radiation sickness Radiation therapy complication Radiation-induced nausea [icd9data.com]

  These are the signs and symptoms most commonly linked to esophagitis: abdominal pain pain and difficulty when swallowing food becoming stuck in the esophagus lack of appetite nausea and possibly vomiting cough pain in the chest when eating, heartburn [medicalnewstoday.com]

  Decreased urine output -Fluid retention, swelling -Fatigue -Confusion -Nausea Lipedema [5] -Symmetrical swelling of both legs, extending from the hips to the ankles caused by deposits of subcutaneous adipose tissue. [physio-pedia.com]

  Symptoms [ edit ] The symptoms of esophagitis include: [2] Heartburn – a burning sensation in the lower mid-chest Nausea Dysphagia – swallowing is painful, with difficulty passing or inability to pass food through the esophagus Vomiting (emesis) Abdominal [en.wikipedia.org]

• Vomiting

  Symptoms Vomiting is one of the most common symptoms of esophagitis, aside from throat pain. [medicalnewstoday.com]

  Vomiting – Acid can irritate esophagus. Hernias – A hernia can poke through the diaphragm muscle and can inhibit the stomach acid and food from draining quickly. [en.wikipedia.org]

  Radiation injury of bone Radiation injury of bone marrow Radiation nephritis Radiation proctitis Radiation recall reaction due to cytotoxic therapy Radiation recall syndrome Radiation sickness Radiation therapy complication Radiation-induced nausea and vomiting [icd9data.com]

  Gastroesophageal reflux is defined as the movement of gastric contents into the esophagus without vomiting. Laryngopharyngeal reflux is the movement of gastric contents into the laryngopharyngeal area. [gastrointestinalatlas.com]

  Acupressure for chemotherapy-induced nausea and vomiting: a randomized clinical trial. Oncol Nurs Forum. 2007;34(4):813–820. 36. Marks LB, Carroll PR, Dugan TC, Anscher MS. [aafp.org]

• Gagging

  This mixture can suppress a persons gag reflex; therefore patients should eat slowly and sit upright for at least 30 minutes after eating to prevent aspiration. Appropriate antibiotic or anti- fungal for infection. [oncolink.org]

  Usually it lasts about a month after you finish. best wishes x LMK74 Brisbane Member Posts: 775 ✭ Hi @JoeyLiz, they did recommend the soluble panadol but I gag on the taste of it. I have been prescribed ordine but yet to fill it. [onlinenetwork.bcna.org.au]

  In patients in whom a cycle of gagging can develop from the thickness of the secretions, lorazepam is useful. A cool mist vaporizer can also help, although if used at home proper cleaning must occur to prevent pseudomonas contamination. [clinicaladvisor.com]

• Dental Caries

  caries due to radiation Disorder due to exposure to ionizing radiation Effect of radiation therapy EFFECT OF RADIATION THERAPY (disorder) Effects of occupational exposure to radiation Environmental exposure of radiation to thyroid Environmental exposure [icd9data.com]

• Chest Pain

  Chest pain of esophageal origin cannot be accurately distinguished from chest pain associated with coronary artery disease (CAD). Therefore, prehospital protocols should be followed for the management of chest pain potentially caused by CAD. [emedicine.medscape.com]

  In Erridge 2005, the 30Gy/10F regimen was significantly better at reducing chest pain and dyspnoea compared to 10Gy/1F. [cochranelibrary.com]

  Patients may present with heartburn, dysphagia, odynophagia, food impaction, weight loss, and chest pain. Progressive dysphagia for solids is the most common presenting symptom. This may progress to include liquids. [gastrointestinalatlas.com]

  (if reflux post stent placement is defined as a complication) Prolonged chest pain caused by stent expansion is more common with larger and more flared stents.case reports of erosion of the stents into the airway or adjacent vascular structures, which [slideshare.net]

  Some studies identify smoking as a risk for pneumonitis, 19 whereas others suggest smoking may lessen the risk. 20 Symptoms of radiation pneumonitis, including low-grade fever, congestion, dry cough, pleuritic chest pain, and a sensation of chest fullness [aafp.org]

• Fracture

  Bone - Decreased bone density - Osteoradionecrosis of the mandible and fractures of the pelvis, hip, long bones and ribs are common - Radiation in children may cause long bones and the spine to mature abnormally if the growth plate is affected Common [physio-pedia.com]

• Ulcer

  In all eight patients, this ulceration or granularity was associated with variable esophageal narrowing within a known radiation portal. [ncbi.nlm.nih.gov]

  Acute damage: mucosal necrosis, submucosal edema Chronic injury: due to fractionated doses of 60 gray or more; submucosal fibrosis, capillary telangiectasia, thick walled arterial vessels, mucus glandular atrophy, atypical fibroblasts; grossly are ulcers [pathologyoutlines.com]

  This endoscopic sequence displays a hiatal hernia, several reflux ulcers, a pseudo diverticula in an ulcer, a big ulcer, erosive gastritis at the antrum and erosive duodenitis. [gastrointestinalatlas.com]

• Erythema

  Endoscopic changes such as erythema and ulceration are also nonspecific and nondiagnostic. Biopsies from affected areas show variable inflammatory changes and radiation-related atypia of endothelial and stromal cells. [ncbi.nlm.nih.gov]

  General Uncommon ~1% of patients getting (thoracic) radiation. [1] Gross/endoscopic Features: Erythema - nonspecific. [1] Microscopic Features: [1] Variable inflammation. Radiation-related nuclear atypia - endothelial cells and stromal cells. [librepathology.org]

  In addition to strictures, typical findings on endoscopy include erosions, erythema, ulceration, and even hemorrhage, but the severity of esophageal damage may not always correlate with reported symptoms. [symptoma.com]

  Demonstrating arytenoid erythema and edema. This 35 year old male with long standing reflux disease. The upper endoscopy displayed refux esophagitis. [gastrointestinalatlas.com]

The initial diagnosis of radiation esophagitis is made through a properly obtained patient history. Physicians must identify prior radiation therapy (implying that information about the underlying illness must also be collected) and a distinction between acute and chronic can be made based on the onset, course, and progression (as well as severity) of findings. The physical examination should focus on excluding oral candidiasis (through inspection of the oral cavity), recurrence of the primary disease (by palpating proximal lymph nodes) and aspiration pneumonia (through lung auscultation) [2]. Although the condition can be identified solely on clinical grounds, imaging studies should be employed to solidify suspicion [2]. Barium swallowing test is useful for detecting strictures and abnormal peristalsis, computed tomography (CT) is indicated for evaluation of disease recurrence and detection of a possible fistula, but endoscopy is regarded as the gold standard for esophageal assessment [1] [2]. In addition to strictures, typical findings on endoscopy include erosions, erythema, ulceration, and even hemorrhage, but the severity of esophageal damage may not always correlate with reported symptoms [1] [2]. Histology can be useful, particularly when opportunistic infections compromise the diagnosis, showing chronic inflammatory changes and extensive fibrosis [1] [2].

Secondary Outcome Measures : Radiation Esophagitis-related Pain During Treatment as Measured During Treatment and 12 Weeks by the Numerical Rating Pain Scale (NRPS) [ Time Frame: Baseline, weekly during treatment, and 12 weeks from the start of treatment [clinicaltrials.gov]

Abstract The esophagus is frequently exposed to radiation during treatment of advanced stages of common cancers such as lung, breast, and esophagus. [ncbi.nlm.nih.gov]

The symptoms of esophagitis and mucositis may occur during the second or third week of radiation therapy, and gradually increase during treatment. [my.clevelandclinic.org]

Patients who are on steroid treatments or have a suppressed immune system from their cancer treatments may develop an esophagitis caused by a fungal infection (esophageal candidiasis). [oncolink.org]

Normally, the prognosis would be good with no serious illnesses. If there are more causes than one, the prognosis could move to fair. [en.wikipedia.org]

A total score based on these factors was able to separate patients with a poor, intermediate or relatively good prognosis ( Table 1 ). [nature.com]

Prognosis for esophagitis is normally good. Esophagitis can be caused by certain allergies. Being overweight increases the risk of esophagitis. Depending on the cause of esophagitis, there are various possible treatments. [medicalnewstoday.com]

Esophageal cancer has a poor prognosis if advanced cancer is diagnosed, but the prognosis of patients with superficial esophageal cancer is acceptable. [spandidos-publications.com]

PS is a well known major determinant of prognosis in these patients. [cochranelibrary.com]

Aged Carcinoma, Non-Small-Cell Lung/pathology Carcinoma, Non-Small-Cell Lung/therapy* Carcinoma, Squamous Cell/pathology Carcinoma, Squamous Cell/therapy Chemoradiotherapy/adverse effects Chemoradiotherapy/methods* Chi-Square Distribution Esophagitis/etiology [ncbi.nlm.nih.gov]

Another etiology (steroid-induced gastritis) should be sought and treated. Radiation pneumonitis is always a diagnosis of exclusion. [clinicaladvisor.com]

Jump to navigation Jump to search Radiation Toxocity: Esophagus Etiology [ edit ] Dysphagia = disordered eating potentially caused by a number of mechanisms, both neurologic and non-neurologic Odynophagia = painful swallowing Swallowing process includes [en.wikibooks.org]

The utility of intralesional injections for strictures with a different etiology needs further elucidation. [nature.com]

Endoscopy is indicated to: Determine the underlying etiology. Exclude malignant&premalignant conditions. Assess the need for therapy. Perform therapy, such as dilation. [slideplayer.com]

Structures every chapter consistently to include Findings, Imaging Modalities, Clinical Presentation, Pathology, Incidence/Prevalence and Epidemiology, What the Referring Physician Needs to Know, Suggested Readings, and Selected Images to make reference [books.google.com]

CA Cancer J Clin 2013, 63: 11-30. 10.3322/caac.21166 View Article PubMed Google Scholar Youlden DR, Cramb SM, Baade PD: The International Epidemiology of Lung Cancer: geographical distribution and secular trends. [ro-journal.biomedcentral.com]

Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2009 Oct. 7(10):1055-61. [Medline]. Nurko S, Rosen R, Furuta GT. [emedicine.medscape.com]

Unlike others on this topic, this text demonstrates how the endoscope incorporates pathophysiology, diagnostic, and treatment modalities into endoscopic practice. [books.google.com]

Clinical, pathophysiologic and radiobiologic aspects”. A review. Acta Oncol. vol. 29. 1990. pp. 401-15. Lutz, ST, Chow, EL, Hartsell, WF, Konski, AA. “A review of hypofractionated palliative radiotherapy”. Cancer. vol. 109. 2007 Apr 15. pp. 1462-70. [clinicaladvisor.com]

Pathophysiology: Reflux esophagitis develops when gastric contents are passively regurgitated into the esophagus. acid, pepsin, and bile irritate the squamous epithelium, leading to erosion and ulceration of esophageal mucosa. [gastrointestinalatlas.com]

- The pathophysiology behind the sclerosis, fibrosis and atrophy is not well understood. Some believe there is a link between vascular endothelial damage and the progression of the fibrosis. [physio-pedia.com]

OBJECTIVE: To systematically assess the clinical effectiveness of Chinese medicines for prevention and treatment of radiation esophagitis by meta-analysis. [ncbi.nlm.nih.gov]

Conclusion Esophagogastric intramural anastomosis can partly reconstruct the cardial function and prevent reflux esophagitis effectively. 18. Objective : To observe clinical effect of ShuangDi Decoction on preventing radiation esophagitis. 18. [sentencedict.com]

Mix, swish, gargle and swallow for mucositis prevention. Mix and swallow for neuropathy prevention. [integrativeoncology-essentials.com]

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3. Bar-Ad V, Ohri N, Werner-Wasik M. Esophagitis, treatment-related toxicity in non-small cell lung cancer. Rev Recent Clin Trials. 2012;7(1):31–35.4
4. Berkey FJ. Managing the adverse effects of radiation therapy. Am Fam Physician. 2010;82(4):381-388, 394.
5. Ahn S, Kahn D, Zhou S, et al. Dosimetric and clinical predictors for radiation-induced esophageal injury. Int J Radiat Oncol Biol Phys. 2005;61(2):335–347.